Healthcare Provider Details

I. General information

NPI: 1417100686
Provider Name (Legal Business Name): EMILY GORDON PIERSON ARNP, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

393 MAJESTIC EAGLE DR
PONTE VEDRA FL
32081-0617
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-8000
  • Fax:
Mailing address:
  • Phone: 904-861-5251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 9217717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: