Healthcare Provider Details

I. General information

NPI: 1396971305
Provider Name (Legal Business Name): ELYSE D BEAUBRUN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 10/07/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4348 SOUTHPOINT BLVD STE 100
JACKSONVILLE FL
32216-0986
US

IV. Provider business mailing address

PO BOX 16568
JACKSONVILLE FL
32245-6568
US

V. Phone/Fax

Practice location:
  • Phone: 904-281-1915
  • Fax: 904-281-1119
Mailing address:
  • Phone: 904-472-2300
  • Fax: 904-472-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3285412
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP 3285412
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN3285412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: