Provider Demographics
NPI:1093399511
Name:DOUCET, KARINA MIREILLE (MD)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:MIREILLE
Last Name:DOUCET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 KINGSLEY AVE.
Mailing Address - Street 2:IN CARE OF BRITTANY TYLER, GME OFFICE
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073
Mailing Address - Country:US
Mailing Address - Phone:904-639-8500
Mailing Address - Fax:
Practice Address - Street 1:2021 PROFESSIONAL CENTER DRIVE, HCA ORANGE PARK FAMILY
Practice Address - Street 2:SUITE #100
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073
Practice Address - Country:US
Practice Address - Phone:904-622-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2023-04-13
Deactivation Date:2023-03-23
Deactivation Code:
Reactivation Date:2023-04-13
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL34179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program