Healthcare Provider Details

I. General information

NPI: 1821836305
Provider Name (Legal Business Name): AMY PERRY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7432
  • Fax: 888-410-0935
Mailing address:
  • Phone: 904-542-7432
  • Fax: 888-410-0935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number9328570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: