Healthcare Provider Details

I. General information

NPI: 1326815614
Provider Name (Legal Business Name): PATRICK AUGUSTYN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 LITTLE RD
TRINITY FL
34655-4411
US

IV. Provider business mailing address

5553 VIOLET DR
NEW PORT RICHEY FL
34652-5152
US

V. Phone/Fax

Practice location:
  • Phone: 727-774-9200
  • Fax:
Mailing address:
  • Phone: 630-849-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL5843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: