Healthcare Provider Details

I. General information

NPI: 1891250486
Provider Name (Legal Business Name): ERIKA FAVORS NISBETT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13927 SHIPWRECK CIR N
JACKSONVILLE FL
32224-1121
US

IV. Provider business mailing address

13927 SHIPWRECK CIR N
JACKSONVILLE FL
32224-1121
US

V. Phone/Fax

Practice location:
  • Phone: 904-570-9404
  • Fax:
Mailing address:
  • Phone: 904-570-9404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP11000506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: