Healthcare Provider Details

I. General information

NPI: 1437048097
Provider Name (Legal Business Name): LENE DOUTHETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LENE SANSONE

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 JOHNS CREEK PKWY
ST AUGUSTINE FL
32092-5075
US

IV. Provider business mailing address

583 JOHNS CREEK PKWY
ST AUGUSTINE FL
32092-5075
US

V. Phone/Fax

Practice location:
  • Phone: 845-675-3655
  • Fax:
Mailing address:
  • Phone: 845-675-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11040485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: