MEDICARE: PODIATRY ASSOCIATES OF FLORIDA, INC.

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1255432746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PODIATRY ASSOCIATES OF FLORIDA, INC.

Provider Business Mailing Address
First Line	:	5911 TIMUQUANA RD UNIT 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7897
Country	:	US
Telephone Number	:	904-251-5053
Fax Number	:	904-224-2002

Provider Business Practice Location Address
First Line	:	4625 E BAY DR STE 106
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-6866
Country	:	US
Telephone Number	:	904-251-5053
Fax Number	:	904-224-2002

Authorized Official
Title or Position	:	CORPORATE ADMINISTRATOR
Name	:	JEANNIE M BASKIN
Credential	:
Telephone Number	:	904-251-5053

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	06/01/2023

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