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General NPI Number Information
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NPI Number | 1003283227
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Entity Type | Individual
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Provider Name | CHRISTY MCEWEN
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Gender | Female
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 836 PRUDENTIAL DR STE 1700B UNIT 1
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8344
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Country | US
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Telephone | 904-398-0125
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Fax | 904-389-1832
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Provider Business Mailing Address
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Address Line | PO BOX 43667
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City | JACKSONVILLE
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State | FL
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Zip | 32203-3667
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Country | US
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Telephone | 904-398-3760
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Fax | 904-389-1832
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP3222112
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License Number State | FL
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