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General NPI Number Information
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NPI Number | 1235505355
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Entity Type | Organization
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Legal Business Name | FLAGLER HOSPITAL INC. (BEHAVIORAL HEALTH)
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Dates
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Enumeration Date | 08/12/2015
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Last Update Date | 06/06/2016
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Provider Practice Location Address
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Address Line | 201 HEALTH PARK BLVD SUITE 211
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5796
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Country | US
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Telephone | 904-819-2295
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Fax | 904-819-2294
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Provider Business Mailing Address
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Address Line | 201 HEALTH PARK BLVD SUITE 211
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5796
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Country | US
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Telephone | 904-819-2295
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Fax | 904-819-2294
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Authorized Official
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Title or Position | PSYCHIATRIC UR COORDINATOR
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Name | MS. DAWN DELANO BROUN
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Credential | LMHC
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Telephone | 904-819-5288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 4392
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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