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General NPI Number Information
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NPI Number | 1740796770
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Entity Type | Individual
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Provider Name | LEE WILLIAM ELGIN III MSN, CRNP, AGACNP-BC
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Gender | Male
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 01/20/2023
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Provider Practice Location Address
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Address Line | 100 ARRICOLA AVE
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-4515
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Country | US
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Telephone | 904-825-4568
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Fax |
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Provider Business Mailing Address
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Address Line | 2460 OLD MOULTRIE RD STE 1
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-4198
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Country | US
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Telephone | 904-293-0299
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 1-108603
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11002556
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License Number State | FL
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