Healthcare Provider Details

I. General information

NPI: 1548305923
Provider Name (Legal Business Name): NORTH FLORIDA FOOT & ANKLE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 TOWN PLAZA AVE STE A
PONTE VEDRA FL
32081-5164
US

IV. Provider business mailing address

465 TOWN PLAZA AVE STE A
PONTE VEDRA FL
32081-5164
US

V. Phone/Fax

Practice location:
  • Phone: 904-236-5023
  • Fax: 904-236-5073
Mailing address:
  • Phone: 904-236-5023
  • Fax: 904-236-5073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW K BARTELL
Title or Position: PRESIDENT
Credential: DPM
Phone: 904-236-5023