Healthcare Provider Details

I. General information

NPI: 1255570594
Provider Name (Legal Business Name): DOUGLAS WADE PALMER ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4207
US

IV. Provider business mailing address

200 VILLAGE GREEN AVE
SAINT JOHNS FL
32259-7924
US

V. Phone/Fax

Practice location:
  • Phone: 904-608-4780
  • Fax:
Mailing address:
  • Phone: 904-399-6096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP 2059612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: