Advantacare Multi-Specialty Group, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

ADVANTACARE MULTI-SPECIALTY GROUP, LLC

Practice address

3546 Saint Johns Bluff Rd S
Suite 108
Jacksonville, FL 32224-2713

Phone

(904) 374-3672

Fax

(904) 813-7156

NPI assigned

Feb 18, 2016

Organization subpart

No

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

Authorized official

Name

Kerri Herzog

Title

Member

Phone

(407) 539-2111

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456272000000",
    "number": "1861851867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "697 MAITLAND AVE",
            "address_2": "SUITE 1001",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327016821",
            "telephone_number": "407-539-2111",
            "fax_number": "407-539-1211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3546 SAINT JOHNS BLUFF RD S",
            "address_2": "SUITE 108",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322242713",
            "telephone_number": "904-374-3672",
            "fax_number": "904-813-7156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANTACARE MULTI-SPECIALTY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-18",
        "last_updated": "2016-02-24",
        "status": "A",
        "authorized_official_last_name": "HERZOG",
        "authorized_official_first_name": "KERRI",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "407-539-2111"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Medicine & Rehabilitation Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Physical Medicine & Rehabilitation Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 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.