Healthcare Provider Details

I. General information

NPI: 1477977403
Provider Name (Legal Business Name): PHILONA AUGUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7419 COUNTRY RUN PKWY
ORLANDO FL
32818-8277
US

IV. Provider business mailing address

7419 COUNTRY RUN PKWY
ORLANDO FL
32818-8277
US

V. Phone/Fax

Practice location:
  • Phone: 321-299-5289
  • Fax:
Mailing address:
  • Phone: 321-299-5289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number6906633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: