Provider Demographics
NPI:1144625724
Name:FIRST COAST SPINE, INC.
Entity type:Organization
Organization Name:FIRST COAST SPINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLT
Authorized Official - Middle Name:MITCHELL
Authorized Official - Last Name:ANDREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-600-3426
Mailing Address - Street 1:2650 MOSLEY RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-7503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4849 FRENCH ST STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-5003
Practice Address - Country:US
Practice Address - Phone:904-600-3426
Practice Address - Fax:904-800-1432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10319111N00000X
363L00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty