Healthcare Provider Details

I. General information

NPI: 1750946158
Provider Name (Legal Business Name): FIRST COAST INTEGRATIVE PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 KINGSLEY LAKE DR STE 601
ST AUGUSTINE FL
32092-3042
US

IV. Provider business mailing address

2220 COUNTY ROAD 210 W STE 108-221
JACKSONVILLE FL
32259-4058
US

V. Phone/Fax

Practice location:
  • Phone: 352-339-3064
  • Fax:
Mailing address:
  • Phone: 352-339-6311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HEATHER LUING
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 352-339-3064