Healthcare Provider Details

I. General information

NPI: 1124336268
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF VETERANS' AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2010
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 STATE ROAD 16
ST AUGUSTINE FL
32092-0600
US

IV. Provider business mailing address

4650 STATE ROAD 16
ST. AUGUSTINE FL
32092-0600
US

V. Phone/Fax

Practice location:
  • Phone: 904-940-2193
  • Fax:
Mailing address:
  • Phone: 904-940-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314000000X
License Number StateFL

VIII. Authorized Official

Name: MS. CLAUDIA R. DAY
Title or Position: PROGRAM DIRECTOR, FDVA
Credential:
Phone: 727-518-3203