NPIMap

Organization Active NPI

Avanti Wellness Center Flllp

  • Clinic/Center
  • St Augustine, FL
National Provider Identifier
1528200029
Registry record updated Aug 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
HCC7499 Issued in FL
Legal business name
AVANTI WELLNESS CENTER FLLLP
Practice address
3574 US 1 S
Suite 113
St Augustine, FL 32086-6466
Phone
(904) 797-3115
Fax
(904) 797-2915
NPI assigned
Mar 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2011

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

Authorized official

Name
Mrs. Randi B Brazer, LCSW
Title
Director of Operations
Phone
(904) 797-3115

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Clinic/Center 261Q00000X HCC7499 FL Primary

Addresses

Primary practice location

3574 US 1 S
Suite 113
St Augustine, FL 32086-6466

Mailing address

3574 US 1 S
Suite 113
St Augustine, FL 32086-6466
Phone (904) 797-3115

Other identifiers 1

IdentifierTypeStateIssuer
001136302MedicaidFL

Other names 1

  • Avanti Wellness Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Avanti Wellness Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1238371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313625600000",
    "number": "1528200029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3574 US 1 S",
            "address_2": "SUITE 113",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866466",
            "telephone_number": "904-797-3115",
            "fax_number": "904-797-2915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3574 US 1 S",
            "address_2": "SUITE 113",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320866466",
            "telephone_number": "904-797-3115",
            "fax_number": "904-797-2915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVANTI WELLNESS CENTER FLLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-30",
        "last_updated": "2011-08-18",
        "status": "A",
        "authorized_official_last_name": "BRAZER",
        "authorized_official_first_name": "RANDI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "904-797-3115",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "HCC7499",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001136302",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avanti Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.