Organization
SUCCESSFUL PATHWAYS TO WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT NASTASI MD (PRESIDENT)
(315) 882-1141
Entity
Organization
Contact information
Practice address
105 OCEANS EDGE DR, PONTE VEDRA BEACH, FL 32082-4047
(315) 882-1141
Mailing address
105 OCEANS EDGE DR, PONTE VEDRA BEACH, FL 32082-4047
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
ME 464816
FL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
ME 464816
FL
2084P0800X
Psychiatry Physician
Primary
ME 464816
FL
Other
Enumeration date
02/16/2015
Last updated
02/16/2015
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