Healthcare Provider Details

I. General information

NPI: 1851743199
Provider Name (Legal Business Name): MAYRA DEJESUS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10739 DEERWOOD PARK BLVD STE 200
JACKSONVILLE FL
32256-4839
US

IV. Provider business mailing address

1792 MEADOWGOLD LN
WINTER PARK FL
32792-6364
US

V. Phone/Fax

Practice location:
  • Phone: 904-719-7707
  • Fax: 800-266-5158
Mailing address:
  • Phone: 407-256-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number2114722
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP2114722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: