Healthcare Provider Details

I. General information

NPI: 1487349155
Provider Name (Legal Business Name): SOPHIA NICOLE GANGUZZA MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8211
US

IV. Provider business mailing address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8211
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11045735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: