Healthcare Provider Details

I. General information

NPI: 1215238563
Provider Name (Legal Business Name): HEART CENTER OF SAINT AUGUSTINE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2010
Last Update Date: 11/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HEALTH PARK BLVD STE 329
SAINT AUGUSTINE FL
32086-5771
US

IV. Provider business mailing address

238 FIDDLERS POINT DR
SAINT AUGUSTINE FL
32080-6133
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-4333
  • Fax: 904-825-4248
Mailing address:
  • Phone: 904-825-4333
  • Fax: 904-825-4248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0064435
License Number StateFL

VIII. Authorized Official

Name: DR. KRISHNA SIKARIA
Title or Position: PHYSCIAN
Credential: M.D.
Phone: 904-825-4333