Healthcare Provider Details

I. General information

NPI: 1194249706
Provider Name (Legal Business Name): NICOLE MARIE BUZARD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 PARK AVENUE STE 403 AND 405
ORANGE PARK FL
32073
US

IV. Provider business mailing address

23343 NW COUNTY ROAD 236
HIGH SPRINGS FL
32643-9669
US

V. Phone/Fax

Practice location:
  • Phone: 904-688-3000
  • Fax: 904-688-3001
Mailing address:
  • Phone: 386-454-0698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9110819
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: