Provider Demographics
NPI:1568146751
Name:ST AUGUSTINE SPECIALTY HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ST AUGUSTINE SPECIALTY HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATRINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:904-495-1610
Mailing Address - Street 1:4255 US HWY 1 S STE 18
Mailing Address - Street 2:#250
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:904-495-1610
Mailing Address - Fax:
Practice Address - Street 1:308 GRACIELA CIR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-7837
Practice Address - Country:US
Practice Address - Phone:210-508-5621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service