Provider Demographics
NPI:1669133799
Name:FIRST COAST PEDIATRICS, PA
Entity type:Organization
Organization Name:FIRST COAST PEDIATRICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMITA
Authorized Official - Middle Name:ZURBANO
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-491-0177
Mailing Address - Street 1:1463 NECTARINE STREET
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA
Mailing Address - State:FL
Mailing Address - Zip Code:32034-3027
Mailing Address - Country:US
Mailing Address - Phone:904-491-0177
Mailing Address - Fax:904-491-3173
Practice Address - Street 1:1463 NECTARINE STREET
Practice Address - Street 2:
Practice Address - City:FERNANDINA
Practice Address - State:FL
Practice Address - Zip Code:32034-3027
Practice Address - Country:US
Practice Address - Phone:904-491-0177
Practice Address - Fax:904-491-3173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty