Basic Information
| Provider Information | |||||||||
| NPI: | 1528396678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | D'AMICO | ||||||||
| FirstName: | CARA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | C-PNP, ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 1798 | ||||||||
| Address2: | |||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320501798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046520870 | ||||||||
| FaxNumber: | 9046522308 | ||||||||
| Practice Location | |||||||||
| Address1: | 10250 NORMANDY BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322218059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9046520870 | ||||||||
| FaxNumber: | 9046522308 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2009 | ||||||||
| LastUpdateDate: | 08/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | ARNP9271693 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 006243100 | 05 | FL | MEDICAID |