Provider Demographics
NPI:1578236394
Name:AVECINA MEDICAL, PA
Entity Type:Organization
Organization Name:AVECINA MEDICAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORETTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-723-4707
Mailing Address - Street 1:9580 APPLECROSS RD STE 106
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-5843
Mailing Address - Country:US
Mailing Address - Phone:904-778-9180
Mailing Address - Fax:904-778-9740
Practice Address - Street 1:5915 NORMANDY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6200
Practice Address - Country:US
Practice Address - Phone:904-379-8085
Practice Address - Fax:904-619-8042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AVECINA MEDICAL PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care