Healthcare Provider Details

I. General information

NPI: 1316293384
Provider Name (Legal Business Name): MARTA KAY SPAULDING WELLS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13720 WEEPING WILLOW WAY
JACKSONVILLE FL
32224-6899
US

IV. Provider business mailing address

13720 WEEPING WILLOW WAY
JACKSONVILLE FL
32224-6899
US

V. Phone/Fax

Practice location:
  • Phone: 904-992-6827
  • Fax:
Mailing address:
  • Phone: 904-992-6827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberARNP1498842
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: