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NPI Code Detail

MEDICARE: JACKSONVILLE PRIMARY CARE PA

MEDICARE: JACKSONVILLE PRIMARY CARE PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianME0046485FL

General Provider Information

NPI Number : 1104981398
Entity Type Code : Organization
Provider Name (Legal Business Name) : JACKSONVILLE PRIMARY CARE PA
Provider Business Mailing Address
First Line : 8016 ATLANTIC BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-8751
Country : US
Telephone Number : 904-838-7581
Fax Number :
Provider Business Practice Location Address
First Line : 8016 ATLANTIC BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32211-8751
Country : US
Telephone Number : 904-838-7581
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CICERON LAZO
Credential : MD
Telephone Number : 904-838-7581
Provider Enumeration Date : 12/27/2006
Last Update Date : 06/03/2026

Similar Medicare Providers

1962567156 — CICERON LAZO MD
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1912338443 — RESA DEMINT B.S. BCABA
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1275924292 — STEPHANIE WILKES
Practice Location Address:
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1073998084 — ASHLEY BRADLEY BCBA
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1336996776 — JAKIYA ALEXIS WHITAKER
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Directions to “JACKSONVILLE PRIMARY CARE PA ” Practice Location

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