MEDICARE: MENDEZ FAMILY 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
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF4853	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205854171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDEZ FAMILY CARE PA

Provider Business Mailing Address
First Line	:	1909 BEACH BLVD STE 102
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-2643
Country	:	US
Telephone Number	:	904-246-2752
Fax Number	:	904-246-2758

Provider Business Practice Location Address
First Line	:	1909 BEACH BLVD STE 102
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-2643
Country	:	US
Telephone Number	:	904-246-2752
Fax Number	:	904-246-2758

Authorized Official
Title or Position	:	CFO
Name	:	ZANDA M CHANDLER
Credential	:
Telephone Number	:	904-589-1112

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	06/09/2023

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Directions to “MENDEZ FAMILY CARE PA ” Practice Location

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