Healthcare Provider Details

I. General information

NPI: 1386577914
Provider Name (Legal Business Name): CARLEE ANN MASTERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 UNF DR
JACKSONVILLE FL
32224-2645
US

IV. Provider business mailing address

589 FALCON FORK WAY
ST JOHNS FL
32259-4399
US

V. Phone/Fax

Practice location:
  • Phone: 904-501-5660
  • Fax:
Mailing address:
  • Phone: 904-501-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: