Healthcare Provider Details

I. General information

NPI: 1447621420
Provider Name (Legal Business Name): JUDITH HEPBURN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH PRATER-HEPBURN ARNP

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 KING ST
JACKSONVILLE FL
32204-2410
US

IV. Provider business mailing address

430 COLLEGE DR SUITE 100-102
MIDDLEBURG FL
32068-8530
US

V. Phone/Fax

Practice location:
  • Phone: 904-760-4904
  • Fax:
Mailing address:
  • Phone: 904-644-8669
  • Fax: 904-298-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP659092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: