Healthcare Provider Details

I. General information

NPI: 1104962257
Provider Name (Legal Business Name): AKUA OWUSU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 REYKO RD STE 100
JACKSONVILLE FL
32207-2828
US

IV. Provider business mailing address

2394 FOXHAVEN DR W
JACKSONVILLE FL
32224-2010
US

V. Phone/Fax

Practice location:
  • Phone: 239-690-6906
  • Fax:
Mailing address:
  • Phone: 904-887-3382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME67605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: