Healthcare Provider Details

I. General information

NPI: 1740477843
Provider Name (Legal Business Name): FIRST COAST INFECTIOUS DISEASE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 01/13/2026
Certification Date: 01/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-8937
US

IV. Provider business mailing address

PO BOX 16488
JACKSONVILLE FL
32245-6488
US

V. Phone/Fax

Practice location:
  • Phone: 904-398-5614
  • Fax: 904-398-5617
Mailing address:
  • Phone: 904-398-5614
  • Fax: 904-398-5617

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 TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME89939
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIDGET ROBERTS
Title or Position: CEO
Credential:
Phone: 904-398-5614