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Specialty details in registry · Saint Johns, FL

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At a glance

845 Durbin Pavilion Dr, Saint Johns, FL 32259-0000

NPPES record updated Aug 16, 2018. Public records can lag behind changes at a practice.

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Practice location

845 Durbin Pavilion Dr
Saint Johns, FL 32259-0000

Professional details: NPI, taxonomy & registry record

NPI1063992378

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Registry details

Primary taxonomy: Specialty details in registry
Taxonomy code: 156FX1800X
Enumeration date: Aug 16, 2018
Record updated: Aug 16, 2018

More registry details

Provider type: Organization · Type 2
Other reported name: <UNAVAIL>

Reported taxonomies and licenses

Specialty details in registry

156FX1800X · Primary

Specialty details in registry

332H00000X

License numbers and credentials are reported to NPPES; HCPList does not independently verify them.

Practice location

845 Durbin Pavilion Dr
Saint Johns, FL 32259-0000

Phone: (479) 277-9170

Mailing address

702 SW 8TH ST

BENTONVILLE, AR 727160445

Source: NPPES Source through Oct 18, 2026An NPI does not verify licensure or credentials.

Information may be outdated or incomplete. Confirm details directly with the practice. HCPList is an independent directory and is not affiliated with CMS.

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