Healthcare Provider Details

I. General information

NPI: 1902727415
Provider Name (Legal Business Name): MOHAMAD CHEHAB APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH PARK BLVD
SAINT AUGUSTINE FL
32086-5784
US

IV. Provider business mailing address

400 HEALTH PARK BLVD
SAINT AUGUSTINE FL
32086-5784
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-5155
  • Fax:
Mailing address:
  • Phone: 904-819-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11049377
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: