Healthcare Provider Details

I. General information

NPI: 1033508924
Provider Name (Legal Business Name): ERIN BECKETT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN JOLLETT

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 PRUDENTIAL DR
JACKSONVILLE FL
32207-8210
US

IV. Provider business mailing address

1892 ADLER NEST LN
FLEMING ISLAND FL
32003-2300
US

V. Phone/Fax

Practice location:
  • Phone: 575-491-4958
  • Fax:
Mailing address:
  • Phone: 575-491-4958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9398485
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberARNP 9398485
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberARNP 9398485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: