Healthcare Provider Details

I. General information

NPI: 1811041015
Provider Name (Legal Business Name): ALLERGY & ASTHMA SPECIALISTS OF NORTH FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1895 KINGSLEY AVE SUITE 401
ORANGE PARK FL
32073-4466
US

IV. Provider business mailing address

1895 KINGSLEY AVE SUITE 401
ORANGE PARK FL
32073-4466
US

V. Phone/Fax

Practice location:
  • Phone: 904-272-5251
  • Fax: 904-276-0459
Mailing address:
  • Phone: 904-730-4870
  • Fax: 904-276-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME25318
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME86337
License Number StateFL

VIII. Authorized Official

Name: PATRICK JOSEPH DEMARCO III
Title or Position: PHYSICIAN
Credential: MD
Phone: 904-272-5251