Healthcare Provider Details

I. General information

NPI: 1689088247
Provider Name (Legal Business Name): LAUREN ASHLEY RHODEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SAN MARCO BLVD SUITE 4A
JACKSONVILLE FL
32207-8568
US

IV. Provider business mailing address

1325 SAN MARCO BLVD SUITE 4A
JACKSONVILLE FL
32207-8568
US

V. Phone/Fax

Practice location:
  • Phone: 904-306-9860
  • Fax:
Mailing address:
  • Phone: 904-306-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9237379
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code364SM0705X
TaxonomyMedical-Surgical Clinical Nurse Specialist
License NumberARNP9237379
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: