Healthcare Provider Details

I. General information

NPI: 1225433758
Provider Name (Legal Business Name): JAN MICHAEL BERNAL TRINIDAD ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAN BERNAL TRINIDAD ARNP

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR STE 1400
JACKSONVILLE FL
32207-8340
US

IV. Provider business mailing address

PO BOX 746647
ATLANTA GA
30374-6647
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-6518
  • Fax: 904-384-1005
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-384-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9285575
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9285575
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: