Healthcare Provider Details

I. General information

NPI: 1053243592
Provider Name (Legal Business Name): AMBER NICOLE OSORIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23916 NW 83RD AVE
RAIFORD FL
32083-1003
US

IV. Provider business mailing address

5903 TAMPICO RD
JACKSONVILLE FL
32244-1740
US

V. Phone/Fax

Practice location:
  • Phone: 904-368-2500
  • Fax:
Mailing address:
  • Phone: 904-935-0677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11046919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: