Individual
DIVLEEN KAUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
400 HEALTH PARK BLVD, ST AUGUSTINE, FL 32086-5784
(904) 819-4497
Mailing address
11534 SUMMERVIEW CIR, JACKSONVILLE, FL 32256-3962
(330) 774-8653
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601008430
MI
363A00000X
Physician Assistant
Primary
PA9114702
FL
Other
Enumeration date
10/02/2017
Last updated
01/18/2023
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