Healthcare Provider Details

I. General information

NPI: 1992846018
Provider Name (Legal Business Name): JAMES ARENDELL PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE ORTHOPAEDIC PLACE
ST AUGUSTINE FL
32086-4202
US

IV. Provider business mailing address

4 VERSAGGI DR
ST AUGUSTINE FL
32080-6926
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-0540
  • Fax: 904-209-1055
Mailing address:
  • Phone: 904-471-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1793
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: