Provider Demographics
NPI:1821367764
Name:NORTHEAST FLORIDA MEDICAL SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:NORTHEAST FLORIDA MEDICAL SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PA-C
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:904-703-3041
Mailing Address - Street 1:1166 AUTUMN POINT CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1166 AUTUMN POINT CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9029
Practice Address - Country:US
Practice Address - Phone:904-703-3041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105630363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty