Healthcare Provider Details

I. General information

NPI: 1063394450
Provider Name (Legal Business Name): GOLDWASSER UROGYNECOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD STE 5010
ST AUGUSTINE FL
32086-3705
US

IV. Provider business mailing address

309 PLAZA
ATLANTIC BEACH FL
32233-5441
US

V. Phone/Fax

Practice location:
  • Phone: 904-535-4104
  • Fax: 877-682-2135
Mailing address:
  • Phone: 904-535-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN GOLDWASSER
Title or Position: OWNER
Credential: MD
Phone: 904-535-4104