MEDICARE: FIRST COAST VEIN, LLC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1457755373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COAST VEIN, LLC

Provider Business Mailing Address
First Line	:	330 A1A N
Second Line	:	SUITE 321
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1823
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 A1A N
Second Line	:	SUITE 321
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-1823
Country	:	US
Telephone Number	:	904-280-0600
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHAHID M NASIR
Credential	:	MD
Telephone Number	:	904-280-0600

Provider Enumeration Date	:	10/21/2014
Last Update Date	:	08/24/2016

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Directions to “FIRST COAST VEIN, LLC ” Practice Location

Language	Start Address	Practice Location

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