Organization
FLORIDA CENTER FOR INFECTIOUS DISEASES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESIREE D CLARK PA-C (PRESIDENT)
(904) 322-1140
Entity
Organization
Contact information
Practice address
14810 OLD SAINT AUGUSTINE RD, SUITE 201, JACKSONVILLE, FL 32258-2451
(904) 292-0863
(904) 212-0884
Mailing address
5055 MONROE FOREST DR, JACKSONVILLE, FL 32257-2204
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME96311
FL
Other
Enumeration date
12/30/2011
Last updated
02/16/2012
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