=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578236394
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVECINA MEDICAL, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2021
-----------------------------------------------------
Last Update Date | 07/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5915 NORMANDY BLVD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32205-6200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-379-8085
-----------------------------------------------------
Fax | 904-619-8042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4815 SWEETGRASS PL STE 201
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32224-0131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-367-3372
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING/CREDENTIALING
-----------------------------------------------------
Name | AMANDA MORETTI KIGHT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 904-367-3372
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------