Healthcare Provider Details

I. General information

NPI: 1649978388
Provider Name (Legal Business Name): ERYKAH LAURYN FARRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTHPARK BLVD # 201
ST AUGUSTINE FL
32086-3129
US

IV. Provider business mailing address

105 SHIELDS CT APT 1316
ST AUGUSTINE FL
32084-2084
US

V. Phone/Fax

Practice location:
  • Phone: 904-417-6236
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13680
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: