Healthcare Provider Details

I. General information

NPI: 1619577566
Provider Name (Legal Business Name): TONI J FIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI JAMISIN VICTORIA FIFE

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N 6TH ST STE 5138
ST AUGUSTINE FL
32084-1920
US

IV. Provider business mailing address

85473 SAGAPONACK DR
FERNANDINA BEACH FL
32034-8785
US

V. Phone/Fax

Practice location:
  • Phone: 904-944-6196
  • Fax:
Mailing address:
  • Phone: 540-771-4204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180392
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024180392
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: