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Organization
TRINITY HEALTH SOUTH PLLC
Active
Organization
TRINITY HEALTH SOUTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY C LU (CREDENTIALING COORDINATOR)
(904) 221-2535
Entity
Organization
Contact information
Practice address
475 W TOWN PL, SUITE 105, ST AUGUSTINE, FL 32092-3648
(904) 806-4579
(904) 863-5566
Mailing address
110 CALLE NORTE, ST AUGUSTINE, FL 32092
(904) 806-4579
(904) 863-5566
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME104865
FL
Other
Enumeration date
11/09/2016
Last updated
11/09/2016
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