Healthcare Provider Details

I. General information

NPI: 1518853472
Provider Name (Legal Business Name): MACY BROOKE NEAL DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MACY BROOKE JACKSON DNP, APRN, FNP-BC

II. Dates (important events)

Enumeration Date: 06/17/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHERIFFS OFFICE DR
MACCLENNY FL
32063-8833
US

IV. Provider business mailing address

1 SHERIFFS OFFICE DR
MACCLENNY FL
32063-8833
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-9482
  • Fax: 904-653-6026
Mailing address:
  • Phone: 904-408-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9537919
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: