| First Coast Nephrology Inc | |
|
4123 University Blvd S Ste E Jacksonville FL 32216-4320 | |
| (904) 744-7300 | |
| (904) 281-5356 |
| Full Name | First Coast Nephrology Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4123 University Blvd S Ste E, Jacksonville, Florida |
| Authorized Official Name and Position | Jamal Saliba Salameh (PRESIDENT) |
| Authorized Official Contact | 9047444448 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Coast Nephrology Inc Po Box 57189 Jacksonville FL 32241-7189 Ph: (904) 737-2722 | First Coast Nephrology Inc 4123 University Blvd S Ste E Jacksonville FL 32216-4320 Ph: (904) 744-7300 |
| NPI Number | 1942625520 |
|---|---|
| Provider Enumeration Date | 02/19/2014 |
| Last Update Date | 05/02/2024 |
| Certification Date | 05/02/2024 |
| Medicare PECOS PAC ID | 3173753126 |
|---|---|
| Medicare Enrollment ID | O20140313000813 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942625520 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Secondary |
| 207RN0300X | Internal Medicine - Nephrology | () | Primary |
| Provider Name | Sohail a Khan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1275745333 PECOS PAC ID: 5698715852 Enrollment ID: I20050506000168 |
| Provider Name | Jamal Saliba Salameh |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1174558753 PECOS PAC ID: 9133143167 Enrollment ID: I20060118000063 |
| Provider Name | Curtis Clausen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114349180 PECOS PAC ID: 0648409029 Enrollment ID: I20140205000521 |
| Provider Name | Randall C Mathson |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1417326190 PECOS PAC ID: 7719297829 Enrollment ID: I20151102001404 |
| Provider Name | Eric Theodore Hutzel |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1487120085 PECOS PAC ID: 2567707565 Enrollment ID: I20181219002488 |
| Provider Name | Travis Austin Jeffords |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366933947 PECOS PAC ID: 8921344607 Enrollment ID: I20190117000846 |
| Provider Name | Raymond Dao |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164988028 PECOS PAC ID: 2860809357 Enrollment ID: I20210330000769 |
| Provider Name | Tamika Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851901284 PECOS PAC ID: 4981007358 Enrollment ID: I20210722000972 |
| Provider Name | Julie a Valentine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215710140 PECOS PAC ID: 7416491022 Enrollment ID: I20240705002858 |
| Provider Name | Sheri Frances Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518778299 PECOS PAC ID: 2466979133 Enrollment ID: I20250506002418 |
| Provider Name | Cynthia a Demola |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1720020167 PECOS PAC ID: 7214918168 Enrollment ID: I20260310003135 |
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