Healthcare Provider Details

I. General information

NPI: 1255403689
Provider Name (Legal Business Name): FIRST COAST PULMONARY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 PINE CONE DR SUITE # 106
PALM COAST FL
32137-8685
US

IV. Provider business mailing address

150 SOUTHPARK BLVD SUITE 208
ST AUGUSTINE FL
32086-5179
US

V. Phone/Fax

Practice location:
  • Phone: 386-986-1422
  • Fax: 386-986-1415
Mailing address:
  • Phone: 904-819-6800
  • Fax: 904-819-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BERNARD R BORBELYQ
Title or Position: PRESIDENT
Credential: MD
Phone: 904-819-6800