Provider Demographics
NPI:1285127688
Name:NE FLORIDA ENTERPRISES, LLC
Entity type:Organization
Organization Name:NE FLORIDA ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPERATING PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-201-3566
Mailing Address - Street 1:101 MARKETSIDE AVE # 404-168
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-1541
Mailing Address - Country:US
Mailing Address - Phone:904-201-3566
Mailing Address - Fax:
Practice Address - Street 1:10175 FORTUNE PKWY UNIT 202
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6748
Practice Address - Country:US
Practice Address - Phone:904-201-3566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994713253Z00000X
FL234803253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care