Healthcare Provider Details

I. General information

NPI: 1174229843
Provider Name (Legal Business Name): CAMILA MARGARITA CARDONA-GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 W 8TH ST
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1017
  • Fax: 904-244-6864
Mailing address:
  • Phone: 904-383-1017
  • Fax: 904-244-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: