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General NPI Number Information
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NPI Number | 1922205251
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Entity Type | Organization
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Legal Business Name | LINA L FEASTER PA
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 2460 OLD MOULTRIE RD SUITE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4197
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Country | US
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Telephone | 904-794-2424
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3463
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3463
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Country | US
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Telephone | 904-794-2424
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Fax |
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Authorized Official
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Title or Position | PRESIDENT MD
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Name | LINA L FEASTER
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Credential |
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Telephone | 904-794-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME79232
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License Number State | FL
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