Healthcare Provider Details

I. General information

NPI: 1023048147
Provider Name (Legal Business Name): LAURA J ROWE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3599 UNIVERSITY BLVD. SOUTH
JACKSONVILLE FL
32216
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD. SOUTH
JACKSONVILLE FL
32216
US

V. Phone/Fax

Practice location:
  • Phone: 904-345-7776
  • Fax: 904-345-7772
Mailing address:
  • Phone: 904-345-7776
  • Fax: 904-345-7772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP753192
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: