Healthcare Provider Details

I. General information

NPI: 1881958783
Provider Name (Legal Business Name): HOLLY BETH DOUCETTE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 06/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 KING ST HEALTH SERVICES
ST AUGUSTINE FL
32084-4342
US

IV. Provider business mailing address

PO BOX 1027
SAINT AUGUSTINE FL
32085-1027
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-6211
  • Fax: 904-824-1183
Mailing address:
  • Phone: 904-819-6211
  • Fax: 904-824-1183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 1637582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: