Provider Demographics
NPI:1124214879
Name:FLORIDA INFECTIOUS DISEASE ASSOCIATES PA
Entity Type:Organization
Organization Name:FLORIDA INFECTIOUS DISEASE ASSOCIATES PA
Other - Org Name:FLORIDA INFECTIOUS DISEASE ASSOCIATES PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANISHA
Authorized Official - Middle Name:GISELLE
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-298-2113
Mailing Address - Street 1:1536 KINGSLEY AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4525
Mailing Address - Country:US
Mailing Address - Phone:904-298-2113
Mailing Address - Fax:904-298-1922
Practice Address - Street 1:1536 KINGSLEY AVE STE 118
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4525
Practice Address - Country:US
Practice Address - Phone:904-298-2113
Practice Address - Fax:904-298-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6621OtherMEDICARE GROUP NUMBER
FL000624500Medicaid
FLK6621OtherMEDICARE GROUP NUMBER