Provider Demographics
NPI:1407893100
Name:SOLANTIC OF JACKSONVILLE, LLC
Entity Type:Organization
Organization Name:SOLANTIC OF JACKSONVILLE, LLC
Other - Org Name:CARESPOT EXPRESS HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:WEBSTER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLINKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-550-0821
Mailing Address - Street 1:10151 DEERWOOD PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0566
Mailing Address - Country:US
Mailing Address - Phone:904-854-1545
Mailing Address - Fax:
Practice Address - Street 1:151 PINE LAKE DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081
Practice Address - Country:US
Practice Address - Phone:904-543-3677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAG648Medicare PIN