LINA L FEASTER PA
Ambulatory Health at Old Moultrie Rd, Saint Augustine, FL

License number
Florida ME79232
Category
Ambulatory Health
Type
Primary Care
Owner
Name: LINA L FEASTER
Title: PRESIDENT MD
Phone: (904) 794-2424
Address
Address
2460 Old Moultrie Rd SUITE 1, Saint Augustine, FL 32086
National Provider ID: 1922205251
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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LINA L. FEASTER, PA

Saint Augustine, FL

Registration:
May 28, 2002
Addresses:
2460 Old Moultrie Rd SUITE 1, Saint Augustine, FL 32086 (Physical)
PO Box 3463, Saint Augustine, FL 32085
State ID:
P02000058360
Business type:
Florida Profit Corporation
President, Director:
Lina L Feaster (President, Director), 721 Camelia Trl, Saint Augustine, FL 32086 (Physical)
Agent:
Lina Feaster,721 Camelia Trl, Saint Augustine, FL 32086 (Physical)
EIN:
043713724

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