Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | MED-PHYS-LIC-11981 | MT |
N | 207RC0000X | Internist - Cardiovascular Disease | 70238631205 | UT |
Y | 207RC0000X | Internist - Cardiovascular Disease | ME151126 | FL |
N | 207RI0011X | Interventional Cardiology | MED-PHYS-LIC-11981 | MT |
NPI | 1891958559 |
---|---|
Provider Name | Dr. Jose N Nativi Nicolau |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 14/07/2021 |