1255403689 NPI number — FIRST COAST PULMONARY ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255403689 NPI number — FIRST COAST PULMONARY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST COAST PULMONARY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255403689
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 SOUTHPARK BLVD
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
ST AUGUSTINE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32086-5179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-819-6800
Provider Business Mailing Address Fax Number:
904-819-6700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 PINE CONE DR
Provider Second Line Business Practice Location Address:
SUITE # 106
Provider Business Practice Location Address City Name:
PALM COAST
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32137-8685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-986-1422
Provider Business Practice Location Address Fax Number:
386-986-1415
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BORBELYQ
Authorized Official First Name:
BERNARD
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
904-819-6800

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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