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General NPI Number Information
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NPI Number | 1760168330
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Entity Type | Organization
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Legal Business Name | BAYSIDE MEDICAL PRACTICE OF VILANO BEACH LLC
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 101 YACHT CLUB DR
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City | ST AUGUSTINE
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State | FL
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Zip | 32084-2196
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Country | US
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Telephone | 904-217-4550
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Fax | 904-907-2113
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Provider Business Mailing Address
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Address Line | 240 SAN MARCO AVE
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32084-2729
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Country | US
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Telephone | 904-217-4550
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Fax | 904-907-2113
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMMY ROWLAND DYE
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Credential | APN
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Telephone | 305-916-0183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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