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NPI Code Detail

MEDICARE: MILLELY JOSEFINA SUMMERS

MEDICARE: MILLELY JOSEFINA SUMMERS
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 PractitionerARNP9354385FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ARNP9354385OTHERFLMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831689678
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILLELY JOSEFINA SUMMERS
Provider Business Mailing Address
First Line : 1689 EAGLE HARBOR PKWY
Second Line : STE B
City : FLEMING ISLAND
State : FL
Zip : 32003-4817
Country : US
Telephone Number : 904-388-3357
Fax Number : 904-384-5746
Provider Business Practice Location Address
First Line : 6444 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2891
Country : US
Telephone Number : 904-805-9600
Fax Number : 904-805-0084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2018
Last Update Date : 04/15/2021

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Directions to “ MILLELY JOSEFINA SUMMERS ” Practice Location

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