MEDICARE: FIRST COAST PODIATRY, P A

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	213E00000X	Podiatrist	PO2487	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1881876902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COAST PODIATRY, P A

Provider Business Mailing Address
First Line	:	3115 SPRING GLEN RD STE 507
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5907
Country	:	US
Telephone Number	:	904-354-1192
Fax Number	:	904-354-1193

Provider Business Practice Location Address
First Line	:	3115 SPRING GLEN RD STE 507
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-5907
Country	:	US
Telephone Number	:	904-354-1192
Fax Number	:	904-354-1193

Authorized Official
Title or Position	:	PODIATRIST
Name	:	JAYNELL SMITH-CAMERON
Credential	:	DPM
Telephone Number	:	904-354-1192

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	06/28/2023

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Directions to “FIRST COAST PODIATRY, P A ” Practice Location

Language	Start Address	Practice Location

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