Healthcare Provider Details

I. General information

NPI: 1013898758
Provider Name (Legal Business Name): KELLY AUCLAIR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY ZONA

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PASEO REYES DR
ST AUGUSTINE FL
32095-8464
US

IV. Provider business mailing address

316 PASEO REYES DR
ST AUGUSTINE FL
32095-8464
US

V. Phone/Fax

Practice location:
  • Phone: 903-544-5800
  • Fax: 903-544-5800
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11041885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: