Organization
ATLANTIC COAST MEDICAL REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACI ROSENSTEIN (ADMINISTRATOR)
(904) 888-6095
Entity
Organization
Contact information
Practice address
13171 ATLANTIC BLVD. SUITE #100, JACKSONVILLE, FL 32225
(904) 888-6095
(904) 280-5238
Mailing address
13171 ATLANTIC BLVD. SUITE #100, JACKSONVILLE, FL 32225
(904) 888-6095
(904) 280-5238
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME79945
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001KM
BLUE CROSS BLUE SHIELD
FL
Enumeration date
03/30/2011
Last updated
06/29/2020
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