Provider Demographics
NPI:1316807175
Name:ST. AUGUSTINE DIRECT PRIMARY CARE, LLC
Entity type:Organization
Organization Name:ST. AUGUSTINE DIRECT PRIMARY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, APRN
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:904-962-7815
Mailing Address - Street 1:2200 N PONCE DE LEON BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2650
Mailing Address - Country:US
Mailing Address - Phone:904-657-5736
Mailing Address - Fax:904-877-5276
Practice Address - Street 1:2200 N PONCE DE LEON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2650
Practice Address - Country:US
Practice Address - Phone:904-657-5736
Practice Address - Fax:904-877-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care