Provider Demographics
NPI:1972708584
Name:ARCILA, MARISOL E (MD)
Entity type:Individual
Prefix:
First Name:MARISOL
Middle Name:E
Last Name:ARCILA
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 57970
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-7970
Mailing Address - Country:US
Mailing Address - Phone:904-737-1838
Mailing Address - Fax:904-737-1206
Practice Address - Street 1:1325 SAN MARCO BLVD STE 4A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8568
Practice Address - Country:US
Practice Address - Phone:904-306-9860
Practice Address - Fax:904-360-9864
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME988592081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL278685100Medicaid
FL278685100Medicaid