| St Augustine Primary Care P L | |
|
811 State Road 206 E Ste 3 St Augustine FL 32086-4869 | |
| (904) 342-2989 | |
| (904) 824-6243 |
| Full Name | St Augustine Primary Care P L |
|---|---|
| Speciality | Family Medicine |
| Location | 811 State Road 206 E Ste 3, St Augustine, Florida |
| Authorized Official Name and Position | Brian David Raymaker (OWNER) |
| Authorized Official Contact | 9043422989 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St Augustine Primary Care P L Po Box 3123 St Augustine FL 32085-3123 Ph: (904) 342-2989 | St Augustine Primary Care P L 811 State Road 206 E Ste 3 St Augustine FL 32086-4869 Ph: (904) 342-2989 |
| NPI Number | 1760654370 |
|---|---|
| Provider Enumeration Date | 03/24/2008 |
| Last Update Date | 11/05/2024 |
| Medicare PECOS PAC ID | 6800960592 |
|---|---|
| Medicare Enrollment ID | O20080729000470 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760654370 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 40261 (Florida) | Primary |
| Provider Name | Judith L Nichols |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255311528 PECOS PAC ID: 7012979008 Enrollment ID: I20041102000317 |
| Provider Name | Brian Raymaker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1184696221 PECOS PAC ID: 2668445776 Enrollment ID: I20080801000100 |
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