MEDICARE: JODY KRISTIN PROPST PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP9320843	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	9320843	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104286863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODY KRISTIN PROPST PMHNP-BC

Provider Business Mailing Address
First Line	:	2800 UNIVERSITY BLVD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3394
Country	:	US
Telephone Number	:	904-256-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5491 DOLPHIN POINT BLVD STE 1300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-3221
Country	:	US
Telephone Number	:	904-256-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	04/15/2024

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Directions to “ JODY KRISTIN PROPST PMHNP-BC” Practice Location

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