Healthcare Provider Details

I. General information

NPI: 1891632261
Provider Name (Legal Business Name): GINGER MICHELLE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 PRINCE PHILLIP DR
ST AUGUSTINE FL
32092-1747
US

IV. Provider business mailing address

196 PRINCE PHILLIP DR
ST AUGUSTINE FL
32092-1747
US

V. Phone/Fax

Practice location:
  • Phone: 949-939-1880
  • Fax:
Mailing address:
  • Phone: 949-939-1880
  • Fax: 949-939-1880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9689520
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: