Healthcare Provider Details

I. General information

NPI: 1366947475
Provider Name (Legal Business Name): TIKILIA DENISE SCOTT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5251 EMERSON ST
JACKSONVILLE FL
32207-4932
US

IV. Provider business mailing address

5251 EMERSON ST
JACKSONVILLE FL
32207-4932
US

V. Phone/Fax

Practice location:
  • Phone: 904-570-4444
  • Fax:
Mailing address:
  • Phone: 904-704-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9280028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: