Healthcare Provider Details

I. General information

NPI: 1366607335
Provider Name (Legal Business Name): FAMILY CARE OF PALM COAST PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 07/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4869 PALM COAST PARKWAY NW 802
PALM COAST FL
32145
US

IV. Provider business mailing address

4869 PALM COAST PKWY NW # 802
PALM COAST FL
32137-3661
US

V. Phone/Fax

Practice location:
  • Phone: 386-445-2003
  • Fax: 386-445-7445
Mailing address:
  • Phone: 386-445-2003
  • Fax: 386-445-7445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number92879
License Number StateFL

VIII. Authorized Official

Name: MARINA RABKIN
Title or Position: PRESIDENT
Credential: MD
Phone: 386-445-2003