Healthcare Provider Details

I. General information

NPI: 1174321822
Provider Name (Legal Business Name): ARIEL RENEE AXSOM APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 NORTON LN STE 101
TALLAHASSEE FL
32308-5973
US

IV. Provider business mailing address

4004 NORTON LN STE 101
TALLAHASSEE FL
32308-5973
US

V. Phone/Fax

Practice location:
  • Phone: 850-518-7626
  • Fax:
Mailing address:
  • Phone: 850-518-7626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN9362829
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11038444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: