Provider Demographics
NPI:1013711498
Name:FIRST COAST CARDIOVASCULAR INSTITUTE LLC
Entity type:Organization
Organization Name:FIRST COAST CARDIOVASCULAR INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YAZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-493-3333
Mailing Address - Street 1:PO BOX 551308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-1308
Mailing Address - Country:US
Mailing Address - Phone:904-493-3333
Mailing Address - Fax:904-493-2222
Practice Address - Street 1:7011 A C SKINNER PKWY STE 160
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6953
Practice Address - Country:US
Practice Address - Phone:904-493-3333
Practice Address - Fax:904-493-2222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST COAST CARDIOVASCULAR INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac Facilities