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General NPI Number Information
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NPI Number | 1528197993
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Entity Type | Organization
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Legal Business Name | FIRST COAST PRIMARY CARE INC
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Dates
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Enumeration Date | 03/03/2007
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 4040 WOODCOCK DR SUITE 250
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City | JACKSONVILLE
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State | FL
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Zip | 32207-2720
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Country | US
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Telephone | 904-400-6103
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Fax | 904-400-6102
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Provider Business Mailing Address
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Address Line | PO BOX 61148
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City | JACKSONVILLE
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State | FL
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Zip | 32236-1148
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Country | US
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Telephone | 904-400-6100
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Fax | 904-400-6102
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Authorized Official
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Title or Position | ADMINISTRATION MANAGER
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Name | LINDA E GOODEN
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Credential |
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Telephone | 904-400-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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