Healthcare Provider Details

I. General information

NPI: 1952231060
Provider Name (Legal Business Name): PINE RIDGE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4534 W RANGER ST
BEVERLY HILLS FL
34465-5614
US

IV. Provider business mailing address

4534 W RANGER ST
BEVERLY HILLS FL
34465-5614
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-6255
  • Fax:
Mailing address:
  • Phone: 352-234-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBYN M STAUBACH
Title or Position: MANAGING MEMBER
Credential: ACNP-C
Phone: 413-281-6051