Healthcare Provider Details

I. General information

NPI: 1487945895
Provider Name (Legal Business Name): FLEMING ISLAND ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 EAGLE HARBOR PKWY
ORANGE PARK FL
32003-4820
US

IV. Provider business mailing address

LB# 8532 PO BOX 95000
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 904-644-0700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: LAURA ADKINS
Title or Position: MANAGER
Credential:
Phone: 828-424-0869