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General NPI Number Information
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NPI Number | 1669710141
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Entity Type | Organization
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Legal Business Name | FLORIDA HEART & VASCULAR CARE, PLLC
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 120 CYPRESS EDGE DR SUITE 203
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City | PALM COAST
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State | FL
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Zip | 32164-8453
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Country | US
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Telephone | 386-586-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 146 PALM COAST RESORT BLVD SUITE 806
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City | PALM COAST
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State | FL
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Zip | 32137-1812
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Country | US
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Telephone | 615-400-0380
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. KAREN CHRISTIANE THEILADE
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Credential | M.D.
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Telephone | 386-237-7353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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