Healthcare Provider Details

I. General information

NPI: 1891714564
Provider Name (Legal Business Name): PAULA STOWELL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 PALENCIA VILLAGE DR STE 101
ST AUGUSTINE FL
32095-8450
US

IV. Provider business mailing address

PO BOX 2230
ST AUGUSTINE FL
32085-2230
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5108
  • Fax: 866-334-0650
Mailing address:
  • Phone: 904-824-4990
  • Fax: 904-824-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP2520572
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2520572
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: