Healthcare Provider Details

I. General information

NPI: 1700044252
Provider Name (Legal Business Name): ST LUCIE ANESTHESIA ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GLADES RD
BOCA RATON FL
33432-1419
US

IV. Provider business mailing address

PO BOX 745923
ATLANTA GA
30374-5923
US

V. Phone/Fax

Practice location:
  • Phone: 877-328-1119
  • Fax:
Mailing address:
  • Phone: 908-653-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: OFFICER
Credential:
Phone: 404-450-4684