| Avanti Wellness Center | |
|
3574 Us 1 S Suite 113 St Augustine FL 32086-6466 | |
| (904) 797-3115 | |
| (904) 797-2915 |
| Full Name | Avanti Wellness Center |
|---|---|
| Speciality | Clinic/center |
| Location | 3574 Us 1 S, St Augustine, Florida |
| Authorized Official Name and Position | Randi B Brazer (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 9047973115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Avanti Wellness Center 3574 Us 1 S Suite 113 St Augustine FL 32086-6466 Ph: (904) 797-3115 | Avanti Wellness Center 3574 Us 1 S Suite 113 St Augustine FL 32086-6466 Ph: (904) 797-3115 |
| NPI Number | 1528200029 |
|---|---|
| Provider Enumeration Date | 03/30/2009 |
| Last Update Date | 08/18/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528200029 | NPI | - | NPPES |
| 001136302 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | HCC7499 (Florida) | Primary |
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