Healthcare Provider Details

I. General information

NPI: 1609000215
Provider Name (Legal Business Name): PETER A. NASSAR, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 03/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 BONNEVAL RD SUITE 2
JACKSONVILLE FL
32216-6084
US

IV. Provider business mailing address

3537 CREST ST
ST AUGUSTINE FL
32092-3801
US

V. Phone/Fax

Practice location:
  • Phone: 904-854-6899
  • Fax: 904-338-0533
Mailing address:
  • Phone: 904-236-9331
  • Fax: 904-338-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME94669
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME94669
License Number StateFL

VIII. Authorized Official

Name: DR. PETER A NASSAR
Title or Position: OWNER
Credential: MD
Phone: 904-236-9331