Healthcare Provider Details

I. General information

NPI: 1265168090
Provider Name (Legal Business Name): FIRST COAST TMS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 PERIMETER PARK BLVD STE 402
JACKSONVILLE FL
32216-1124
US

IV. Provider business mailing address

PO BOX 17726
JACKSONVILLE FL
32245-7726
US

V. Phone/Fax

Practice location:
  • Phone: 904-647-6238
  • Fax: 904-490-9035
Mailing address:
  • Phone: 904-647-6238
  • Fax: 904-647-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER D GAMMARANO
Title or Position: OWNER
Credential:
Phone: 904-647-6238