Healthcare Provider Details

I. General information

NPI: 1972169951
Provider Name (Legal Business Name): TONY D HAYES APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIRCLIFF WAY
JACKSONVILLE FL
32204
US

IV. Provider business mailing address

1 SHIRCLIFF WAY
JACKSONVILLE FL
32204-4748
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-7300
  • Fax:
Mailing address:
  • Phone: 904-308-8435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11002592
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: