Florida Center for Infectious Diseases, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME96311 Issued in FL

Legal business name

FLORIDA CENTER FOR INFECTIOUS DISEASES, INC.

Practice address

14810 Old Saint Augustine Rd
Suite 201
Jacksonville, FL 32258-2451

Phone

(904) 292-0863

Fax

(904) 212-0884

NPI assigned

Dec 30, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Desiree D Clark, PA-C

Title

President

Phone

(904) 322-1140

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1316217896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5055 MONROE FOREST DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322572204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14810 OLD SAINT AUGUSTINE RD",
            "address_2": "SUITE 201",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582451",
            "telephone_number": "904-292-0863",
            "fax_number": "904-212-0884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA CENTER FOR INFECTIOUS DISEASES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-30",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-322-1140",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME96311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.