Healthcare Provider Details

I. General information

NPI: 1053711788
Provider Name (Legal Business Name): AMY ELIZABETH MACLEAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4866 BIG ISLAND DR SUITE 5
JACKSONVILLE FL
32246-7498
US

IV. Provider business mailing address

4866 BIG ISLAND DR SUITE 5
JACKSONVILLE FL
32246-7498
US

V. Phone/Fax

Practice location:
  • Phone: 904-652-0652
  • Fax:
Mailing address:
  • Phone: 904-652-0652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9168850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: