DNS Waiver Support Coordinator

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

DNS WAIVER SUPPORT COORDINATOR

Practice address

4451 Marsh Hawk Dr S
Jacksonville, FL 32218-9173

Phone

(904) 729-9770

NPI assigned

Oct 18, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Deborah Nurse-Sellers

Title

Owner

Phone

(904) 729-9770

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476748800000",
    "number": "1376094086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 MARSH HAWK DR S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322189173",
            "telephone_number": "904-729-9770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4451 MARSH HAWK DR S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322189173",
            "telephone_number": "904-729-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DNS WAIVER SUPPORT COORDINATOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-18",
        "last_updated": "2016-10-18",
        "status": "A",
        "authorized_official_last_name": "NURSE-SELLERS",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-729-9770"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.