Healthcare Provider Details

I. General information

NPI: 1447717400
Provider Name (Legal Business Name): ELIZABETH MORGAN IRELAND RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

6 BURGUNDY DR
LAKE SAINT LOUIS MO
63367-1515
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone: 636-699-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number2016042168
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: