Healthcare Provider Details

I. General information

NPI: 1508950072
Provider Name (Legal Business Name): ANNE TERESA HESSON REESER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 KINGSLEY AVE SUITE 1100
ORANGE PARK FL
32073-4479
US

IV. Provider business mailing address

4800 BELFORT RD
JACKSONVILLE FL
32256-6004
US

V. Phone/Fax

Practice location:
  • Phone: 904-264-9797
  • Fax: 904-264-4644
Mailing address:
  • Phone: 904-483-5826
  • Fax: 904-265-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number900067
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9329975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: