Provider Demographics
NPI:1003579178
Name:PODIATRY ASSOCIATES OF FLORIDA, INC.
Entity Type:Organization
Organization Name:PODIATRY ASSOCIATES OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-251-5053
Mailing Address - Street 1:5911 TIMUQUANA RD UNIT 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7897
Mailing Address - Country:US
Mailing Address - Phone:904-251-5053
Mailing Address - Fax:904-224-2002
Practice Address - Street 1:4625 E BAY DR STE 106
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6866
Practice Address - Country:US
Practice Address - Phone:904-251-5053
Practice Address - Fax:904-224-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty