Healthcare Provider Details

I. General information

NPI: 1235505355
Provider Name (Legal Business Name): FLAGLER HOSPITAL INC. (BEHAVIORAL HEALTH)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HEALTH PARK BLVD SUITE 211
ST AUGUSTINE FL
32086-5796
US

IV. Provider business mailing address

201 HEALTH PARK BLVD SUITE 211
ST AUGUSTINE FL
32086-5796
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-2295
  • Fax: 904-819-2294
Mailing address:
  • Phone: 904-819-2295
  • Fax: 904-819-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN DELANO BROUN
Title or Position: PSYCHIATRIC UR COORDINATOR
Credential: LMHC
Phone: 904-819-5288