Healthcare Provider Details

I. General information

NPI: 1477219632
Provider Name (Legal Business Name): TURNBRIDGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SPRING ST
ST AUGUSTINE FL
32084-0432
US

IV. Provider business mailing address

87 SPRING ST
ST AUGUSTINE FL
32084-0432
US

V. Phone/Fax

Practice location:
  • Phone: 904-591-4150
  • Fax:
Mailing address:
  • Phone: 904-591-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN COIT KRUG
Title or Position: PRESIDENT
Credential:
Phone: 904-591-4150