Healthcare Provider Details

I. General information

NPI: 1295156297
Provider Name (Legal Business Name): MARY LEEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-1940
US

IV. Provider business mailing address

1905 CORPORATE SQUARE BLVD
JACKSONVILLE FL
32216-1940
US

V. Phone/Fax

Practice location:
  • Phone: 904-720-0599
  • Fax: 904-720-5225
Mailing address:
  • Phone: 904-720-0599
  • Fax: 904-720-5225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP1057712
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: