Healthcare Provider Details

I. General information

NPI: 1093697575
Provider Name (Legal Business Name): SARAH MARTYN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 JENKINS ST
ST AUGUSTINE FL
32086-5167
US

IV. Provider business mailing address

10700 QUAIL RIDGE DR
PONTE VEDRA FL
32081-8832
US

V. Phone/Fax

Practice location:
  • Phone: 904-808-0514
  • Fax:
Mailing address:
  • Phone: 904-599-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: