Healthcare Provider Details

I. General information

NPI: 1255744421
Provider Name (Legal Business Name): KAITLIN MARIE STANDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLIN AUSTIN

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 ATLANTIC BLVD
ATLANTIC BEACH FL
32233-3311
US

IV. Provider business mailing address

997 ATLANTIC BLVD
ATLANTIC BEACH FL
32233-3311
US

V. Phone/Fax

Practice location:
  • Phone: 904-647-1849
  • Fax:
Mailing address:
  • Phone: 904-647-1849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: