NORTHEAST FLORIDA PLASTIC SURGERY NPI 1073745634

NPI Information

  • NPI: 1073745634
  • Provider Name: NORTHEAST FLORIDA PLASTIC SURGERY
  • Classification: Specialist - 174400000X
  • Entity Type: Organization
  • CLIA Number: 10D0966520
  • Address: 421 KINGSLEY AVE
    #200
    ORANGE PARK, FL
    ZIP 32073
  • Phone: (904) 215-5800

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NPI Details

NORTHEAST FLORIDA PLASTIC SURGERY is a specialist in Orange Park, FL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. NORTHEAST FLORIDA PLASTIC SURGERY NPI is 1073745634. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

421 KINGSLEY AVE
#200
ORANGE PARK, FL
ZIP 32073-897
Phone: (904) 215-5800
Fax: (904) 215-1211

The provider's authorized official is Eric Andrew Weiss .
The authorized official title is President and has the following contact phone number (904) 215-5800.

The CLIA number assigned to this NPI record is 10D0966520 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/17/2009 and was last updated on 3/2/2012.

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
1174400000XSpecialistME0062500FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1F42140MEDICARE UPINFLORIDA
218187AMEDICARE PINFLORIDA

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: 11/21/2025

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