Healthcare Provider Details

I. General information

NPI: 1417593534
Provider Name (Legal Business Name): CHIELOKA OKOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2019
Last Update Date: 07/20/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4266 SUNBEAM RD
JACKSONVILLE FL
32257-2425
US

IV. Provider business mailing address

4266 SUNBEAM RD
JACKSONVILLE FL
32257-2425
US

V. Phone/Fax

Practice location:
  • Phone: 904-407-7700
  • Fax: 904-407-6001
Mailing address:
  • Phone: 904-407-7700
  • Fax: 904-407-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11002492
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11002492
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: