MEDICARE: AVECINA MEDICAL PA

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
1	261QU0200X	Urgent Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053981142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVECINA MEDICAL PA

Provider Business Mailing Address
First Line	:	4815 SWEETGRASS PL STE 201
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4160 SOUTHSIDE BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-8500
Country	:	US
Telephone Number	:	904-900-1717
Fax Number	:	904-367-2143

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	AMANDA MORETTI KIGHT
Credential	:
Telephone Number	:	904-723-4707

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	07/29/2024

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Directions to “AVECINA MEDICAL PA ” Practice Location

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