Healthcare Provider Details

I. General information

NPI: 1255657979
Provider Name (Legal Business Name): CARMEN LILIANA ISACHE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 03/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 W 6TH ST
JACKSONVILLE FL
32206-4324
US

IV. Provider business mailing address

653 W 8TH ST # L14
JACKSONVILLE FL
32209-6511
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-1040
  • Fax: 904-253-1931
Mailing address:
  • Phone: 904-244-7514
  • Fax: 904-244-5650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME122625
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME122625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: