Healthcare Provider Details

I. General information

NPI: 1629132931
Provider Name (Legal Business Name): FLORIDA SCHOOL FOR THE DEAF AND THE BLIND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 SAN MARCO AVE
ST AUGUSTINE FL
32084-2762
US

IV. Provider business mailing address

207 SAN MARCO AVE
ST AUGUSTINE FL
32084-2762
US

V. Phone/Fax

Practice location:
  • Phone: 904-827-2535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: STAN GUSTETIC
Title or Position: DIRECTOR OF RELATED SERVICES
Credential:
Phone: 904-827-2535