Provider Demographics
NPI:1922205251
Name:LINA L FEASTER PA
Entity Type:Organization
Organization Name:LINA L FEASTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT MD
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-794-2424
Mailing Address - Street 1:PO BOX 3463
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3463
Mailing Address - Country:US
Mailing Address - Phone:904-794-2424
Mailing Address - Fax:
Practice Address - Street 1:2460 OLD MOULTRIE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4197
Practice Address - Country:US
Practice Address - Phone:904-794-2424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79232261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5053Medicare PIN