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General NPI Number Information
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NPI Number | 1013711498
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Entity Type | Organization
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Legal Business Name | FIRST COAST CARDIOVASCULAR INSTITUTE LLC
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Dates
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Enumeration Date | 04/03/2025
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Last Update Date | 04/03/2025
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Provider Practice Location Address
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Address Line | 7011 A C SKINNER PKWY STE 160
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City | JACKSONVILLE
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State | FL
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Zip | 32256-6953
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Country | US
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Telephone | 904-493-3333
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Fax | 904-493-2222
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Provider Business Mailing Address
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Address Line | PO BOX 551308
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City | JACKSONVILLE
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State | FL
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Zip | 32255-1308
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Country | US
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Telephone | 904-493-3333
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Fax | 904-493-2222
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Authorized Official
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Title or Position | PRESIDENT
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Name | YAZAN KHATIB
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Credential | MD
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Telephone | 904-493-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0404X
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Taxonomy Name | Cardiac Rehabilitation Clinic/Center
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License Number |
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License Number State |
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