Healthcare Provider Details

I. General information

NPI: 1770108706
Provider Name (Legal Business Name): ANSAARIE CARDIAC & ENDOVASCULAR CENTER OF EXCELLENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PLANTATION ISLAND DR S STE 302A
ST AUGUSTINE FL
32080-3117
US

IV. Provider business mailing address

209 PINEHURST POINTE DR
SAINT AUGUSTINE FL
32092-3703
US

V. Phone/Fax

Practice location:
  • Phone: 386-232-9203
  • Fax: 386-222-3064
Mailing address:
  • Phone: 386-232-9203
  • Fax: 386-222-3064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: IMRAAN ANSAARIE
Title or Position: OWNER
Credential:
Phone: 386-232-9203