Healthcare Provider Details

I. General information

NPI: 1629326285
Provider Name (Legal Business Name): CISCA PULMONARY CRITICAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 245
JACKSONVILLE BEACH FL
32250
US

IV. Provider business mailing address

1361 13TH AVE S STE 245
JACKSONVILLE BEACH FL
32250-3238
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-7174
  • Fax: 904-694-0696
Mailing address:
  • Phone: 904-396-0300
  • Fax: 904-396-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS AUGUSTINE VAZQUEZ
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 904-419-3986