Healthcare Provider Details

I. General information

NPI: 1912449463
Provider Name (Legal Business Name): VERONICA WITTMAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 BLANDING BLVD
JACKSONVILLE FL
32244-1957
US

IV. Provider business mailing address

120 KING ST
JACKSONVILLE FL
32204-2410
US

V. Phone/Fax

Practice location:
  • Phone: 904-760-4904
  • Fax:
Mailing address:
  • Phone: 904-760-4904
  • Fax: 904-800-6347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9315674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: