Healthcare Provider Details

I. General information

NPI: 1831689678
Provider Name (Legal Business Name): MILLELY JOSEFINA SUMMERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 BEACH BLVD
JACKSONVILLE FL
32216-2891
US

IV. Provider business mailing address

1689 EAGLE HARBOR PKWY STE B
FLEMING ISLAND FL
32003-4817
US

V. Phone/Fax

Practice location:
  • Phone: 904-805-9600
  • Fax: 904-805-0084
Mailing address:
  • Phone: 904-388-3357
  • Fax: 904-384-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9354385
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: