Healthcare Provider Details

I. General information

NPI: 1831007343
Provider Name (Legal Business Name): CHRISTY MARIE ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 MARKET DR
FLEMING ISLAND FL
32003-4326
US

IV. Provider business mailing address

7751 BELFORT PKWY STE 350
JACKSONVILLE FL
32256-6951
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-6201
  • Fax: 904-264-6858
Mailing address:
  • Phone: 904-363-7453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11049302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: