Healthcare Provider Details

I. General information

NPI: 1801897186
Provider Name (Legal Business Name): CASEY S. ADAMS CNM, ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 MAX LEGGETT PKWY
JACKSONVILLE FL
32218-7273
US

IV. Provider business mailing address

12123 AMBROSIA CT
JACKSONVILLE FL
32223-3545
US

V. Phone/Fax

Practice location:
  • Phone: 904-383-1000
  • Fax:
Mailing address:
  • Phone: 904-654-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP2562942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number2562942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: