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General NPI Number Information
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NPI Number | 1740477843
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Entity Type | Organization
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Legal Business Name | FIRST COAST INFECTIOUS DISEASE CONSULTANTS LLC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 2122 UNIVERSITY BLVD S
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City | JACKSONVILLE
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State | FL
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Zip | 32216-8937
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Country | US
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Telephone | 904-398-5614
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Fax | 904-398-5617
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Provider Business Mailing Address
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Address Line | PO BOX 16488
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City | JACKSONVILLE
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State | FL
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Zip | 32245-6488
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Country | US
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Telephone | 904-398-5614
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Fax | 904-398-5617
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Authorized Official
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Title or Position | CEO
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Name | BRIDGET ROBERTS
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Credential |
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Telephone | 904-398-5614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease 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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME89939
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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