=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003794751
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIFE INTEGRATIVE HEALTH PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 N 6TH ST STE 5138
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32084-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-944-6196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2800 N 6TH ST STE 5138
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32084-1920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-944-6196
-----------------------------------------------------
Fax | 904-341-5481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. TONI FIFE
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 540-771-4202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------