Healthcare Provider Details

I. General information

NPI: 1780168682
Provider Name (Legal Business Name): CARDIOCARE OF JACKSONVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 AUTUMN COVE CIR
FLEMING ISLAND FL
32003-3229
US

IV. Provider business mailing address

2136 AUTUMN COVE CIR
FLEMING ISLAND FL
32003-3229
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-3351
  • Fax: 904-388-2138
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUCIEN ABBOUD
Title or Position: OWNER
Credential: MD
Phone: 904-388-3351