Healthcare Provider Details

I. General information

NPI: 1922630128
Provider Name (Legal Business Name): MICHAEL WALKER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 PRUDENTIAL DR STE 1700
JACKSONVILLE FL
32207-8344
US

IV. Provider business mailing address

836 PRUDENTIAL DR STE 1700
JACKSONVILLE FL
32207-8344
US

V. Phone/Fax

Practice location:
  • Phone: 904-720-0799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005960
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: