Healthcare Provider Details

I. General information

NPI: 1942706130
Provider Name (Legal Business Name): MEDONE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 S PONCE DE LEON BLVD STE 4&5
SAINT AUGUSTINE FL
32084-6007
US

IV. Provider business mailing address

841 S PONCE DE LEON BLVD STE 4
ST AUGUSTINE FL
32084-6008
US

V. Phone/Fax

Practice location:
  • Phone: 352-694-6331
  • Fax: 352-694-6338
Mailing address:
  • Phone: 904-907-2229
  • Fax: 904-342-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL BURNHAM
Title or Position: ADMIN
Credential:
Phone: 352-694-6331