OCTAVIO CARRENO MD PA
Medical Practice at Professional Center Dr, Orange Park, FL

License number
Florida ME78105
Category
Medical Practice
Type
Specialist
Owner
Name: MRS. CONNIE ADKINS
Title: OFFICE MANAGER
Phone: (904) 272-3200
Address
Address
2035 Professional Center Dr SUITE A, Orange Park, FL 32073
National Provider ID: 1023210804
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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OCTAVIO CARRENO, M.D., PA

Orange Park, FL

Status:
Inactive
Inactive reason:
ADMIN DISSOLUTION FOR ANNUAL REPORT
Registration:
Aug 30, 2002
Inactive since:
Sep 14, 2007
Addresses:
1555 Kingsley Ave SUITE 604 & 605, Orange Park, FL 32073 (Physical)
605 1555 Kingsley Ave, Orange Park, FL 32073
State ID:
P02000094659
Business type:
Florida Profit Corporation
President:
Octavio Md Carreno President, inactive, 1555 Kingsley Ave, Orange Park, FL 32073 (Physical)
Agent:
John Tolson,462 Kingsley Ave SUITE 101, Orange Park, FL 32073 (Physical)
EIN:
320043362

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