Healthcare Provider Details

I. General information

NPI: 1972324176
Provider Name (Legal Business Name): KENDAL TIFFANY GALURA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WHITEHALL DR STE 108
ST AUGUSTINE FL
32086-5268
US

IV. Provider business mailing address

PO BOX 100296
GAINESVILLE FL
32610-0296
US

V. Phone/Fax

Practice location:
  • Phone: 904-615-1794
  • Fax: 904-341-5552
Mailing address:
  • Phone: 352-627-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11036060
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11036060
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: