Individual
MARC LEI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
55 PASADENA DR, SAINT AUGUSTINE, FL 32095-9100
(386) 864-0551
Mailing address
55 PASADENA DR, SAINT AUGUSTINE, FL 32095-9100
(386) 864-0551
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5255699
FL
Other
Enumeration date
04/07/2026
Last updated
04/07/2026
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us