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General NPI Number Information
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NPI Number | 1366752842
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Entity Type | Individual
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Provider Name | EMILY OPDYCKE APRN
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Gender | Female
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 14540 OLD SAINT AUGUSTINE RD STE 2497
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City | JACKSONVILLE
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State | FL
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Zip | 32258-7420
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Country | US
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Telephone | 904-260-0352
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Fax | 904-260-0353
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Provider Business Mailing Address
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Address Line | 8149 POINT MEADOWS WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32256-9111
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Country | US
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Telephone | 904-260-0352
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Fax | 904-363-9818
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN9479682
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License Number State | FL
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