Healthcare Provider Details

I. General information

NPI: 1497527865
Provider Name (Legal Business Name): MARYANN DEL CID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 OLD DIXIE HWY
ST AUGUSTINE FL
32084-4190
US

IV. Provider business mailing address

2465 US HIGHWAY 1 S # 111
ST AUGUSTINE FL
32086-6076
US

V. Phone/Fax

Practice location:
  • Phone: 904-829-2273
  • Fax: 904-824-0724
Mailing address:
  • Phone: 661-210-9782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11028932
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11028932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: