Healthcare Provider Details

I. General information

NPI: 1891554549
Provider Name (Legal Business Name): RENEE ASHLEY MORECROFT-PHILLIPPS MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE ASHLEY MORECROFT MBBS

II. Dates (important events)

Enumeration Date: 03/15/2024
Last Update Date: 03/15/2024
Certification Date: 03/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 PROFESSIONAL CENTER DR STE 100
ORANGE PARK FL
32073-4461
US

IV. Provider business mailing address

2021 PROFESSIONAL CENTER DR STE 100
ORANGE PARK FL
32073-4461
US

V. Phone/Fax

Practice location:
  • Phone: 904-639-2005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: