Healthcare Provider Details

I. General information

NPI: 1427899418
Provider Name (Legal Business Name): SEVANISTA D MCKEE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SEVA D MCKEE APRN

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 PLANTATION ISLAND DR S STE 9
ST AUGUSTINE FL
32080-3106
US

IV. Provider business mailing address

113 SEA GROVE MAIN ST UNIT 201
ST AUGUSTINE FL
32080-3307
US

V. Phone/Fax

Practice location:
  • Phone: 904-460-9191
  • Fax: 904-471-4859
Mailing address:
  • Phone: 904-514-8478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11034427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: