Healthcare Provider Details

I. General information

NPI: 1154051571
Provider Name (Legal Business Name): REBECCA MARIE NOLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MARIE BARRETT

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 LONGLEAF PINE PKWY STE 200
JACKSONVILLE FL
32259-7529
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-652-0800
  • Fax: 904-652-0811
Mailing address:
  • Phone: 904-398-7205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11020006
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: