Provider Demographics
NPI:1982631503
Name:FEASTER, LINA LEE (MD)
Entity Type:Individual
Prefix:
First Name:LINA
Middle Name:LEE
Last Name:FEASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:904-794-2772
Practice Address - Street 1:105 MARINER HEALTH WAY
Practice Address - Street 2:STE 207
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3251
Practice Address - Country:US
Practice Address - Phone:904-794-2424
Practice Address - Fax:904-794-2772
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH48468Medicare UPIN
FL02848AMedicare ID - Type Unspecified