Healthcare Provider Details

I. General information

NPI: 1639015423
Provider Name (Legal Business Name): DIVINE SOLUTIONS GROUP SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 PURYEAR ST FL USA
ST AUGUSTINE FL
32084-0569
US

IV. Provider business mailing address

924 PURYEAR ST FL USA
ST AUGUSTINE FL
32084-0569
US

V. Phone/Fax

Practice location:
  • Phone: 904-479-8998
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DAVIANA HOLLIMON
Title or Position: MGR
Credential:
Phone: 904-479-8998