East Coast Neuro LLC
Psychiatry & Neurology, Neurology in Jacksonville, FL. Organization (NPI-2).
NPI number1124424643
StatusActive
Last updated in NPPESJan 22, 2026
Details
- NPI
- 1124424643
- Entity type
- Organization (NPI-2)
- Legal business name
- East Coast Neuro LLC
- Organization subpart
- No
- Enumeration date
- Nov 11, 2014
- Certification date
- Jan 22, 2026
- Last updated
- Jan 22, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology, Neurology | – | – | Yes |
| 208100000X | Physical Medicine & Rehabilitation | – | – | |
| 225100000X | Physical Therapist | – | – | |
| 111NN0400X | Chiropractor, Neurology | – | – |
Other names
- East Coast Injury Clinic (Doing Business As)
Practice location
10550 Deerwood Park Blvd Ste 609aJacksonville, FL 32256-2811
Phone 904-513-3954 · Fax 904-212-0223
Mailing address
Po Box 936957Atlanta, GA 31193-6957
Phone 941-209-5410 · Fax 941-209-5652
Other practice locations
13453 N Main St Ste 302
Jacksonville, FL 32218-2773
Jacksonville, FL 32218-2773
Phone 904-513-3954
Authorized official
Vanessa Jaclyn Wilczak
Owner And Authorized Official
9045133954
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