Healthcare Provider Details

I. General information

NPI: 1194362384
Provider Name (Legal Business Name): ABBY SAPP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY BERTHOLF

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 PARK ST
JACKSONVILLE FL
32204-3811
US

IV. Provider business mailing address

2121 PARK ST
JACKSONVILLE FL
32204-3811
US

V. Phone/Fax

Practice location:
  • Phone: 904-387-6200
  • Fax:
Mailing address:
  • Phone: 904-387-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11002782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: