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NPI Code Detail

MEDICARE: KELLI M. TYSON ARNP

MEDICARE: KELLI M. TYSON ARNP
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
1363L00000XNurse PractitionerARNP9229212FL

Other Identifiers

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

General Provider Information

NPI Number : 1801304357
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLI M. TYSON ARNP
Provider Business Mailing Address
First Line : 5191 FIRST COAST TECH PKWY FL 3
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32224-0609
Country : US
Telephone Number : 904-223-3321
Fax Number : 904-223-2169
Provider Business Practice Location Address
First Line : 1100 PLANTATION ISLAND DR S STE 220
Second Line :
City : ST AUGUSTINE
State : FL
Zip : 32080-5174
Country : US
Telephone Number : 904-223-3321
Fax Number : 904-223-2169
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2018
Last Update Date : 12/19/2024

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Directions to “ KELLI M. TYSON ARNP” Practice Location

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