JOHN R ISTAD PA NPI 1720381452

NPI Information

  • NPI: 1720381452
  • Provider Name: JOHN R ISTAD PA
  • Classification: Clinic/Center - 261QM2500X
  • Specialization: Medical Specialty
  • Entity Type: Organization
  • Address: 1105 SE PORT ST LUCIE BLVD
    PORT SAINT LUCIE, FL
    ZIP 34952
  • Phone: (772) 398-5400

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NPI Details

JOHN R ISTAD PA is a medical specialty clinic center in Port Saint Lucie, FL. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). JOHN R ISTAD PA NPI is 1720381452. The provider is registered as an organization entity type.

The provider's business location address is:

1105 SE PORT ST LUCIE BLVD
PORT SAINT LUCIE, FL
ZIP 34952-332
Phone: (772) 398-5400
Fax: (772) 398-6600

The provider's authorized official is John R Istad .
The authorized official title is Owner and has the following contact phone number (772) 398-5400.

The enumeration date for this NPI number is 12/20/2010 and was last updated on 3/11/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical SpecialtyCH6232FLORIDAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
122649MEDICARE PINFLORIDA
2U24555MEDICARE UPINFLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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