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FLEMING ISLAND PLASTIC SURGERY LLC
NPI 1245602069
Surgery - Plastic and Reconstructive Surgery in Fleming Island, FL

Active since October 21, 2015CLIA 10D2146607 · Waiver
1715 EAGLE HARBOR PKWY STE B, FLEMING ISLAND, FL 32003(904) 990-3477(904) 621-9272 Get Directions Write a Review

NPPES record last updated: September 13, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Sep 13, 2024, Dec 24, 2015 (2 updates tracked since 2015).

About Fleming Island Plastic Surgery Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FLEMING ISLAND PLASTIC SURGERY LLC (NPI 1245602069) is a healthcare organization registered as a plastic and reconstructive surgery in Fleming Island, Florida and active in the NPI registry since October 2015. The organization holds a CLIA Waiver certificate valid through April 2, 2028 and lists William Wallace, Manager/owner, as its authorized official.

NPPES Registry Identity

NPI1245602069
Entity TypeOrganization
Primary Taxonomy2086S0122X
Legal Business NameFLEMING ISLAND PLASTIC SURGERY LLC
Location Address1715 EAGLE HARBOR PKWY STE BFleming Island, FL 32003-4324
Mailing Address916 Alameda LnSaint Johns, FL 32259-6903 · (904) 348-0727 · Fax (904) 621-9272
Phone(904) 990-3477
Fax(904) 621-9272
Organization SubpartNo
Authorized OfficialWilliam WallaceManager/owner · (904) 990-3477
Enumeration DateOctober 21, 2015
Last NPPES UpdateSeptember 13, 20242 updates tracked since enumeration
NPPES CertifiedSeptember 13, 2024
✔ NPI 1245602069 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySurgery · Plastic and Reconstructive SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0122X
License✔ Licensed in FL · ME107749
Definition
A surgeon who specializes in plastic and reconstructive surgery.
1715 EAGLE HARBOR PKWY STE B, Fleming Island, FL 32003
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2146607

Fleming Island Plastic Surgery, LLC · Fleming Island, FL
Active · expires Apr 2, 2028
CLIA Number10D2146607
Laboratory TypePhysician Office
Certificate Effective DateApril 3, 2026
Certificate Expiration DateApril 2, 2028
Laboratory DirectorWilliam A. Wallace
Laboratory Phone(904) 990-3477
Laboratory LocationFleming Island Plastic Surgery, LLC1715 Eagle Harbor Parkway Ste B, Fleming Island, FL 32003
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARIA N RAFAEL NP
Nurse Practitioner (Family)
1715 EAGLE HARBOR PKWY STE B
FLEMING ISLAND, FL 32003
Duval County (904) 990-3477

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fleming Island Plastic Surgery LLC's NPI number?

The NPI number for Fleming Island Plastic Surgery LLC is 1245602069. It was assigned to this organization in the NPPES registry on October 21, 2015.

Where is Fleming Island Plastic Surgery LLC located?

Fleming Island Plastic Surgery LLC is located at 1715 Eagle Harbor Pkwy Ste B, Fleming Island, FL 32003. The listed phone number is (904) 990-3477.

What is Fleming Island Plastic Surgery LLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Plastic and Reconstructive Surgery, with taxonomy code 2086S0122X.

Does Fleming Island Plastic Surgery LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2146607) is associated with this NPI, valid through April 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fleming Island Plastic Surgery LLC was last updated on September 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.