Healthcare Provider Details

I. General information

NPI: 1831547025
Provider Name (Legal Business Name): CATHLEEN MINACCI ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7406 FULLERTON ST SUITE 200
JACKSONVILLE FL
32256-3552
US

IV. Provider business mailing address

5038 ASHINGTON LANDING DR
TAMPA FL
33647-3514
US

V. Phone/Fax

Practice location:
  • Phone: 904-538-0440
  • Fax:
Mailing address:
  • Phone: 813-615-8934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2994432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: