Healthcare Provider Details

I. General information

NPI: 1740633635
Provider Name (Legal Business Name): SOUND PHYSICIANS OF FLORIDA IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2016
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MEMORIAL MEDICAL PKWY
PALM COAST FL
32164-5980
US

IV. Provider business mailing address

1222 DEMONBREUN ST STE 1601
NASHVILLE TN
37203-7092
US

V. Phone/Fax

Practice location:
  • Phone: 615-377-5658
  • Fax:
Mailing address:
  • Phone: 253-682-6040
  • Fax: 888-241-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LAURA FALL
Title or Position: MANAGER
Credential:
Phone: 253-682-6040