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201 Health Park Blvd Suite 211 St Augustine FL 32086-5796 | |
| (904) 819-2295 | |
| (904) 819-2294 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 201 Health Park Blvd, St Augustine, Florida |
| Authorized Official Name and Position | Dawn Delano Broun (PSYCHIATRIC UR COORDINATOR) |
| Authorized Official Contact | 9048195288 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
201 Health Park Blvd Suite 211 St Augustine FL 32086-5796 Ph: (904) 819-2295 | 201 Health Park Blvd Suite 211 St Augustine FL 32086-5796 Ph: (904) 819-2295 |
| NPI Number | 1235505355 |
|---|---|
| Provider Enumeration Date | 08/12/2015 |
| Last Update Date | 06/06/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235505355 | NPI | - | NPPES |
| 010171100 | Medicaid | FL |
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