Healthcare Provider Details

I. General information

NPI: 1033763487
Provider Name (Legal Business Name): FLAGLER PROFESSIONAL HEALTH CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEALTH PARK BLVD STE 5002
ST AUGUSTINE FL
32086-3705
US

IV. Provider business mailing address

PO BOX 3266
ST AUGUSTINE FL
32085-3266
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-5861
  • Fax: 904-819-5862
Mailing address:
  • Phone: 904-819-4602
  • Fax: 904-819-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON PAUL BARRETT
Title or Position: AO
Credential:
Phone: 904-819-4400