Healthcare Provider Details

I. General information

NPI: 1326184573
Provider Name (Legal Business Name): MAUREEN RICCITELLO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 US HIGHWAY 1 S SUITE 1
ST AUGUSTINE FL
32086-6351
US

IV. Provider business mailing address

3100 US HIGHWAY 1 S SUITE 1
ST AUGUSTINE FL
32086-6351
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-4990
  • Fax: 904-824-2226
Mailing address:
  • Phone: 904-824-4990
  • Fax: 904-824-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP2771522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: