Healthcare Provider Details

I. General information

NPI: 1972708584
Provider Name (Legal Business Name): MARISOL E ARCILA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SAN MARCO BLVD STE 4A
JACKSONVILLE FL
32207-8568
US

IV. Provider business mailing address

PO BOX 57970
JACKSONVILLE FL
32241-7970
US

V. Phone/Fax

Practice location:
  • Phone: 904-306-9860
  • Fax: 904-360-9864
Mailing address:
  • Phone: 904-737-1838
  • Fax: 904-737-1206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberME98859
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: