Healthcare Provider Details

I. General information

NPI: 1124214879
Provider Name (Legal Business Name): FLORIDA INFECTIOUS DISEASE ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 KINGSLEY AVE STE 106
ORANGE PARK FL
32073-4503
US

IV. Provider business mailing address

2 SHIRCLIFF WAY STE 700
JACKSONVILLE FL
32204-4759
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-6161
  • Fax: 904-389-5332
Mailing address:
  • Phone: 904-389-5333
  • Fax: 904-389-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JANET YATES
Title or Position: CREDENTIALS SPECIALIST
Credential: RMA
Phone: 904-389-5333