Healthcare Provider Details

I. General information

NPI: 1033451380
Provider Name (Legal Business Name): CRESCENT BEACH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6573 A1A SOUTH
ST AUGUSTINE FL
32080
US

IV. Provider business mailing address

6573 A1A SOUTH
ST AUGUSTINE FL
32080
US

V. Phone/Fax

Practice location:
  • Phone: 904-342-7363
  • Fax: 904-342-7367
Mailing address:
  • Phone: 904-342-7363
  • Fax: 904-342-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIAN S. LONG
Title or Position: OWNER/MEMBER MANAGED
Credential: MD
Phone: 904-342-7363