Provider Demographics
NPI:1336763044
Name:MAYTIN INTEGRATED HEALTHCARE, INC
Entity type:Organization
Organization Name:MAYTIN INTEGRATED HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYTN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:904-923-4782
Mailing Address - Street 1:12443 SAN JOSE BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8650
Mailing Address - Country:US
Mailing Address - Phone:904-923-4782
Mailing Address - Fax:
Practice Address - Street 1:12443 SAN JOSE BLVD STE 403
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-8650
Practice Address - Country:US
Practice Address - Phone:904-923-4782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty