Healthcare Provider Details

I. General information

NPI: 1578664074
Provider Name (Legal Business Name): PODIATRY ASSOCIATES OF FLORIDA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1361 13TH AVE S STE 120
JACKSONVILLE BEACH FL
32250-3233
US

IV. Provider business mailing address

2140 KINGSLEY AVE STE 12
ORANGE PARK FL
32073-5129
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-2001
  • Fax: 904-224-2002
Mailing address:
  • Phone: 904-224-2001
  • Fax: 904-224-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JEANNIE M BASKIN
Title or Position: CORPORATE ADMINISTRATOR
Credential:
Phone: 904-251-5053