Healthcare Provider Details

I. General information

NPI: 1558746644
Provider Name (Legal Business Name): NORTH FLORIDA FACIAL PLASTIC SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7807 BAYMEADOWS RD E SUITE 303
JACKSONVILLE FL
32256-9664
US

IV. Provider business mailing address

3500 VIA DE LA REINA
JACKSONVILLE FL
32217-3673
US

V. Phone/Fax

Practice location:
  • Phone: 904-247-8522
  • Fax: 904-247-9722
Mailing address:
  • Phone: 904-247-8522
  • Fax: 904-247-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberME77632
License Number StateFL

VIII. Authorized Official

Name: JUAN F. GARCIA
Title or Position: OWNER
Credential: MD
Phone: 904-247-8522