Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fleming Island Plastic Surgery LLC

Organization Plastic and Reconstructive Surgery Physician · NPI 1245602069

Fleming Island Plastic Surgery LLC is a Plastic and Reconstructive Surgery Physician in Fleming Island, Florida. Licensed in Florida. Registered with an NPI since 2015.

Licensed in
FL
In the registry since
2015
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

See every abbreviation used in this directory →

Practice location Address checks out

1715 Eagle Harbor Pkwy Ste B
Fleming Island, FL 32003-4324
Phone: (904) 990-3477
Fax: (904) 621-9272
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Plastic and Reconstructive Surgery Physician (primary) Taxonomy 2086S0122X · Licence ME107749 (FL)

Record details

NPI number1245602069
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official William Wallace — Manager/Owner · (904) 990-3477
NPI enumeratedOctober 21, 2015
Last updated in NPPESSeptember 13, 2024
Certification dateSeptember 13, 2024
Mailing address916 Alameda Ln, Saint Johns, FL 32259-6903

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