Healthcare Provider Details

I. General information

NPI: 1144130832
Provider Name (Legal Business Name): WESLEY VERNAL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1382 BROOKWOOD FOREST BLVD
JACKSONVILLE FL
32225-9038
US

IV. Provider business mailing address

1382 BROOKWOOD FOREST BLVD
JACKSONVILLE FL
32225-9038
US

V. Phone/Fax

Practice location:
  • Phone: 904-581-9819
  • Fax:
Mailing address:
  • Phone: 904-581-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11050340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: