Healthcare Provider Details

I. General information

NPI: 1578201372
Provider Name (Legal Business Name): SARAH QUIGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 A1A S STE 102
SAINT AUGUSTINE FL
32080-6523
US

IV. Provider business mailing address

113 A ST
SAINT AUGUSTINE FL
32080-6801
US

V. Phone/Fax

Practice location:
  • Phone: 904-864-6077
  • Fax:
Mailing address:
  • Phone: 904-864-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: