Healthcare Provider Details

I. General information

NPI: 1346530698
Provider Name (Legal Business Name): PAULA C PINKERTON BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULA CHRISTINE RIEDEL AS

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US1 SOUTH SUITE C-2
ST AUGUSTINE FL
32086-5786
US

IV. Provider business mailing address

1955 US1 SOUTH SUITE C-2
ST AUGUSTINE FL
32086-5786
US

V. Phone/Fax

Practice location:
  • Phone: 904-209-6001
  • Fax: 904-209-6002
Mailing address:
  • Phone: 904-209-6001
  • Fax: 904-209-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: