Provider Demographics
NPI:1851789242
Name:AUGUSTINE, GRACE SHARON (ARNP)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:SHARON
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:S
Other - Last Name:FRANCIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:190 JFK DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1186
Mailing Address - Country:US
Mailing Address - Phone:561-964-3003
Mailing Address - Fax:561-434-5653
Practice Address - Street 1:190 JFK DR
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1186
Practice Address - Country:US
Practice Address - Phone:561-964-3003
Practice Address - Fax:561-434-5653
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3072102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIF107ZMedicare PIN