Provider Demographics
NPI:1669775037
Name:PACIFICA CARE PLLC
Entity type:Organization
Organization Name:PACIFICA CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ARCANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-221-2232
Mailing Address - Street 1:13121 ATLANTIC BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225
Mailing Address - Country:US
Mailing Address - Phone:904-221-2232
Mailing Address - Fax:904-221-2205
Practice Address - Street 1:13121 ATLANTIC BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225
Practice Address - Country:US
Practice Address - Phone:904-221-2232
Practice Address - Fax:904-221-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9102783261QM0850X
FLHCC8789261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292650400Medicaid
FLU6812AMedicare PIN
FL292650400Medicaid