Healthcare Provider Details

I. General information

NPI: 1184565137
Provider Name (Legal Business Name): EMERGENCY MEDICINE PROFESSIONALS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 STATE ROAD 207
ST AUGUSTINE FL
32086-9309
US

IV. Provider business mailing address

222 S PENINSULA DR
DAYTONA BEACH FL
32118-4422
US

V. Phone/Fax

Practice location:
  • Phone: 904-257-1414
  • Fax: 904-257-1415
Mailing address:
  • Phone: 386-310-2160
  • Fax: 386-310-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDY ALDERMAN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 386-310-3529