Healthcare Provider Details

I. General information

NPI: 1316807175
Provider Name (Legal Business Name): ST. AUGUSTINE DIRECT PRIMARY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 N PONCE DE LEON BLVD STE 1
ST AUGUSTINE FL
32084-2650
US

IV. Provider business mailing address

2200 N PONCE DE LEON BLVD STE 1
ST AUGUSTINE FL
32084-2650
US

V. Phone/Fax

Practice location:
  • Phone: 904-657-5736
  • Fax: 904-877-5276
Mailing address:
  • Phone: 904-657-5736
  • Fax: 904-877-5276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARGARET E. CORRIGAN
Title or Position: OWNER, APRN
Credential: APRN
Phone: 904-962-7815