Healthcare Provider Details

I. General information

NPI: 1912374489
Provider Name (Legal Business Name): JESSICA ANNE HOUGH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 RIVERPLACE BLVD
JACKSONVILLE FL
32207-9017
US

IV. Provider business mailing address

1510 RIVERPLACE BLVD
JACKSONVILLE FL
32207-9017
US

V. Phone/Fax

Practice location:
  • Phone: 904-346-0050
  • Fax: 904-346-0080
Mailing address:
  • Phone: 904-346-0050
  • Fax: 904-346-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberARNP9273839
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: