Healthcare Provider Details

I. General information

NPI: 1205244019
Provider Name (Legal Business Name): NOOR FARIS DAOUD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 SAN JOSE BLVD
JACKSONVILLE FL
32257-6203
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-262-9204
  • Fax: 904-390-7462
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: