Healthcare Provider Details

I. General information

NPI: 1992310585
Provider Name (Legal Business Name): FELICIA KARWACKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FELICIA KAVALEC

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 NW ENTERPRISE WAY
LAKE CITY FL
32055-8837
US

IV. Provider business mailing address

2460 OLD MOULTRIE RD STE 1
ST AUGUSTINE FL
32086-4198
US

V. Phone/Fax

Practice location:
  • Phone: 386-487-6357
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: