FIRST COAST COMMUNITY WELLNESS SERVICES LLC NPI 1336879097

NPI Information

NPI: 1336879097
Provider Name: FIRST COAST COMMUNITY WELLNESS SERVICES LLC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Organization

Specialization: Psychiatric/Mental Health

CLIA Number: 10D2269927

Address:
5610 FORT CAROLINE RD
JACKSONVILLE, FL
ZIP 32277
Phone: (904) 374-4637
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FIRST COAST COMMUNITY WELLNESS SERVICES LLC is a psychiatric/mental health nurse practitioner in Jacksonville, FL. FIRST COAST COMMUNITY WELLNESS SERVICES LLC NPI is 1336879097. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

5610 FORT CAROLINE RD
JACKSONVILLE, FL
ZIP 32277-799
Phone: (904) 374-4637

The provider's authorized official is Monica Johnson .
The authorized official title is Mgr and has the following contact phone number (904) 497-2192.

The CLIA number assigned to this NPI record is 10D2269927 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/15/2022 and was last updated on 5/23/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LA2200X	Nurse Practitioner	Adult Health			No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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