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NPI Code Detail

MEDICARE: MRS. MARISSA P GARCIA MSH, R.D

MEDICARE: MRS. MARISSA P GARCIA MSH, R.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1133V00000XRegistered DietitianLD001051GA
2133V00000XRegistered DietitianND0000057FL

General Provider Information

NPI Number : 1053480749
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARISSA P GARCIA MSH, R.D
Provider Business Mailing Address
First Line : 1900 CORPORATE SQUARE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-1941
Country : US
Telephone Number : 904-899-4500
Fax Number : 904-899-4534
Provider Business Practice Location Address
First Line : 1900 CORPORATE SQUARE BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-1941
Country : US
Telephone Number : 904-899-4500
Fax Number : 904-899-4534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2006
Last Update Date : 05/09/2013

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