Provider Demographics
NPI:1538647912
Name:VAUGHN, AUTUMN BETH (AP, DIP OM)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:BETH
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:AP, DIP OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-7860
Mailing Address - Country:US
Mailing Address - Phone:352-665-8884
Mailing Address - Fax:
Practice Address - Street 1:8777 SAN JOSE BLVD STE 701
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4292
Practice Address - Country:US
Practice Address - Phone:352-665-8884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3654171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist