Provider Demographics
NPI:1992531149
Name:COWFORD MEDICAL LLC
Entity type:Organization
Organization Name:COWFORD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENIECE
Authorized Official - Middle Name:C
Authorized Official - Last Name:BREMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-219-7552
Mailing Address - Street 1:14114 MAHOGANY AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5513
Mailing Address - Country:US
Mailing Address - Phone:904-219-7552
Mailing Address - Fax:
Practice Address - Street 1:1670 EAGLE HARBOR PKWY
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4820
Practice Address - Country:US
Practice Address - Phone:904-644-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered