Healthcare Provider Details

I. General information

NPI: 1275937179
Provider Name (Legal Business Name): KELLY COX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY O'BRIEN

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 THE GREENS WAY STE 200
JACKSONVILLE BEACH FL
32250-1422
US

IV. Provider business mailing address

1680 THE GREENS WAY STE 200
JACKSONVILLE BEACH FL
32250-1422
US

V. Phone/Fax

Practice location:
  • Phone: 904-800-7380
  • Fax: 904-467-8932
Mailing address:
  • Phone: 904-800-7380
  • Fax: 904-467-8932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9270387
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9270387
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: