Healthcare Provider Details

I. General information

NPI: 1881176584
Provider Name (Legal Business Name): CHARLYN SANTONIL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SOUTHPARK BLVD STE C300
ST AUGUSTINE FL
32086
US

IV. Provider business mailing address

105 SOUTHPARK BLVD STE C300
ST AUGUSTINE FL
32086-4162
US

V. Phone/Fax

Practice location:
  • Phone: 904-808-7246
  • Fax: 904-808-7090
Mailing address:
  • Phone: 904-808-7246
  • Fax: 904-808-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9191744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: