Healthcare Provider Details

I. General information

NPI: 1639418015
Provider Name (Legal Business Name): ACCESS URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10440 US 1 N SUITE 101
ST AUGUSTINE FL
32095-8459
US

IV. Provider business mailing address

10440 US 1 N SUITE 101
ST AUGUSTINE FL
32095-8459
US

V. Phone/Fax

Practice location:
  • Phone: 904-519-8895
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME85579
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME89960
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9359300
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME89508
License Number StateFL

VIII. Authorized Official

Name: MICHAEL HAGHIGHI
Title or Position: CO OWNER
Credential: MD
Phone: 904-519-8895