Healthcare Provider Details

I. General information

NPI: 1073987376
Provider Name (Legal Business Name): JAMIE MABERRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2015
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4530
US

IV. Provider business mailing address

915 N COURTENAY PKWY
MERRITT ISLAND FL
32953-4530
US

V. Phone/Fax

Practice location:
  • Phone: 321-441-8749
  • Fax:
Mailing address:
  • Phone: 321-441-8749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP8280
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11028445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: