Provider Demographics
NPI:1124872502
Name:MARIGOLD FAMILY CARE LLC
Entity type:Organization
Organization Name:MARIGOLD FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-276-5731
Mailing Address - Street 1:5235 ANGEL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7544
Mailing Address - Country:US
Mailing Address - Phone:850-276-5731
Mailing Address - Fax:850-248-2469
Practice Address - Street 1:5235 ANGEL LAKE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-7544
Practice Address - Country:US
Practice Address - Phone:904-274-2007
Practice Address - Fax:850-248-2469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty