Provider Demographics
NPI:1194768879
Name:NAVAL HOSPITAL JACKSONVILLE
Entity type:Organization
Organization Name:NAVAL HOSPITAL JACKSONVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PRACTICE RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGIANA
Authorized Official - Middle Name:LOBO
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-542-7975
Mailing Address - Street 1:1403 WALNUT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4411
Mailing Address - Country:US
Mailing Address - Phone:904-264-6711
Mailing Address - Fax:
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD0000Medicare UPIN