Provider Demographics
NPI:1821008806
Name:AGUSTIN, MARIA (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:AGUSTIN
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4614 BAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7812
Mailing Address - Country:US
Mailing Address - Phone:850-969-0518
Mailing Address - Fax:
Practice Address - Street 1:4614 BAYBROOK DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-7812
Practice Address - Country:US
Practice Address - Phone:850-969-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3377292171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider