Healthcare Provider Details

I. General information

NPI: 1336515931
Provider Name (Legal Business Name): J C HALL ARNP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 PEAR AVE
BUNNELL FL
32110-4887
US

IV. Provider business mailing address

3760 PEAR AVE
BUNNELL FL
32110-4887
US

V. Phone/Fax

Practice location:
  • Phone: 386-793-6628
  • Fax: 386-437-5912
Mailing address:
  • Phone: 386-793-6628
  • Fax: 386-437-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9216912
License Number StateFL

VIII. Authorized Official

Name: JOELLA CAULEY HALL
Title or Position: ARP/OWNER
Credential: ARNP
Phone: 386-793-6628