Provider Demographics
NPI:1093399511
Name:DOUCET, KARINA MIREILLE (MD)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:MIREILLE
Last Name:DOUCET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-383-1002
Mailing Address - Fax:904-244-5965
Practice Address - Street 1:655 W 8TH ST FL CENTER4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-383-1002
Practice Address - Fax:904-244-5965
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2024-08-29
Deactivation Date:2023-03-23
Deactivation Code:
Reactivation Date:2023-04-13
Provider Licenses
StateLicense IDTaxonomies
FL34179207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine