Provider Demographics
NPI:1154942563
Name:FAMILIES FIRST MEDICAL GROUP LLC
Entity type:Organization
Organization Name:FAMILIES FIRST MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLZENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:904-608-0095
Mailing Address - Street 1:8246 RIDING CLUB RD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7266
Mailing Address - Country:US
Mailing Address - Phone:904-707-6042
Mailing Address - Fax:
Practice Address - Street 1:11555 CENTRAL PKWY STE 402
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-2695
Practice Address - Country:US
Practice Address - Phone:904-747-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty