Healthcare Provider Details

I. General information

NPI: 1366484842
Provider Name (Legal Business Name): BONNI G. TITCOMB A.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 ROBERTS DR SIOTE 323
JACKSONVILLE BEACH FL
32250-3264
US

IV. Provider business mailing address

PO BOX 16568
JACKSONVILLE FL
32245-6568
US

V. Phone/Fax

Practice location:
  • Phone: 904-241-9775
  • Fax: 904-249-3638
Mailing address:
  • Phone: 904-472-2300
  • Fax: 904-472-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP 624442
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: