Healthcare Provider Details

I. General information

NPI: 1073143178
Provider Name (Legal Business Name): JESSICA RENEE KEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5147 N 9TH AVE STE 325A
PENSACOLA FL
32504-8700
US

IV. Provider business mailing address

4205 BELFORT RD STE 4015
JACKSONVILLE FL
32216-3623
US

V. Phone/Fax

Practice location:
  • Phone: 850-475-9025
  • Fax: 850-494-7855
Mailing address:
  • Phone: 904-450-6014
  • Fax: 904-450-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11005601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: