Healthcare Provider Details

I. General information

NPI: 1003753765
Provider Name (Legal Business Name): ERGI SPAHO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 PASEO REYES DR
ST AUGUSTINE FL
32095-8464
US

IV. Provider business mailing address

140 BARTRAM PARKE DR
JACKSONVILLE FL
32259-4275
US

V. Phone/Fax

Practice location:
  • Phone: 904-554-5800
  • Fax:
Mailing address:
  • Phone: 904-802-9699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9121908
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: