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General NPI Number Information
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NPI Number | 1568514503
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE FAMILY PRACTICE PA
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 550 WELLS RD SUITE 17
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City | ORANGE PARK
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State | FL
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Zip | 32073-2969
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Country | US
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Telephone | 904-269-2900
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Fax | 904-269-1140
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Provider Business Mailing Address
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Address Line | 550 WELLS RD SUITE 17
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City | ORANGE PARK
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State | FL
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Zip | 32073-2969
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Country | US
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Telephone | 904-269-2900
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Fax | 904-269-1140
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JAMES CANNON
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Credential |
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Telephone | 904-269-2900
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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 | ME0052191
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS7923
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2719
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9101422
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License Number State | FL
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