Healthcare Provider Details

I. General information

NPI: 1184201758
Provider Name (Legal Business Name): DANA RACHAEL EYERLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MARSH LANDING PKWY STE 105A
JACKSONVILLE BEACH FL
32250-1408
US

IV. Provider business mailing address

PO BOX 746638
ATLANTA GA
30374-6638
US

V. Phone/Fax

Practice location:
  • Phone: 904-280-1225
  • Fax: 904-390-7505
Mailing address:
  • Phone: 904-202-1032
  • Fax: 904-376-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME168605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: