Healthcare Provider Details

I. General information

NPI: 1033046701
Provider Name (Legal Business Name): RACHEL GREEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4331
US

IV. Provider business mailing address

5025 FOXGLOVE CIR
LAKELAND FL
33811-2494
US

V. Phone/Fax

Practice location:
  • Phone: 904-222-6656
  • Fax:
Mailing address:
  • Phone: 814-860-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11047167
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: