Healthcare Provider Details

I. General information

NPI: 1962653212
Provider Name (Legal Business Name): JUDITH G REWIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1747 BAPTIST CLAY DR STE 320
FLEMING ISLAND FL
32003-8503
US

IV. Provider business mailing address

PO BOX 43667
JACKSONVILLE FL
32203-3667
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-5185
  • Fax: 904-278-7284
Mailing address:
  • Phone: 904-720-0599
  • Fax: 904-376-4036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP3266942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: