Healthcare Provider Details

I. General information

NPI: 1447339528
Provider Name (Legal Business Name): JACKSONVILLE CARDIOVASCULAR CENTER PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4131 UNIVERSITY BLVD S STE 17
JACKSONVILLE FL
32216-4346
US

IV. Provider business mailing address

6444 BEACH BLVD
JACKSONVILLE FL
32216-2891
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-9600
  • Fax: 904-805-0084
Mailing address:
  • Phone: 904-805-9600
  • Fax: 904-805-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME53377
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: WADDAH SALMAN
Title or Position: OWNER
Credential: MD
Phone: 904-805-9600