Healthcare Provider Details

I. General information

NPI: 1578856803
Provider Name (Legal Business Name): DAVID J SCOTTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 05/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 US 1 S STE 100
ST AUGUSTINE FL
32086-5788
US

IV. Provider business mailing address

1955 US 1 S STE 100
ST AUGUSTINE FL
32086-5788
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-5055
  • Fax:
Mailing address:
  • Phone: 904-825-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: