Individual provider Active NPI

Marshall Poulin, APRN

  • Family Nurse Practitioner
  • St Augustine, FL
National Provider Identifier
1356206650
Registry record updated Jul 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN11047813 Issued in FL
Practice address
100 Arricola Ave
St Augustine, FL 32080-4515
Phone
(904) 825-4368
NPI assigned
Dec 18, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LF0000X APRN11047813 FL Primary
Family Medicine Physician 207Q00000X RN.1641150 CO

Addresses

Primary practice location

100 Arricola Ave
St Augustine, FL 32080-4515

Mailing address

2460 Old Moultrie Rd Ste 1
St Augustine, FL 32086-4198
Phone (904) 825-4368

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2460 Old Moultrie Rd
Suite 1
St Augustine, FL 32086-4197

863 E Dorchester Dr
Saint Johns, FL 32259-3261

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN.1641150COMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1766016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785110400000",
    "number": "1356206650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 OLD MOULTRIE RD STE 1",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320864198",
            "telephone_number": "904-825-4368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ARRICOLA AVE",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320804515",
            "telephone_number": "904-825-4368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULIN",
        "first_name": "MARSHALL",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-12-18",
        "last_updated": "2026-07-27",
        "certification_date": "2026-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11047813",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "RN.1641150",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.