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General NPI Number Information
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NPI Number | 1497263297
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Entity Type | Individual
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Provider Name | SALACIA CUNNINGHAM
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Gender | Female
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 10199 SOUTHSIDE BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32256-0758
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Country | US
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Telephone | 850-510-9142
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Fax | 850-510-9142
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Provider Business Mailing Address
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Address Line | 5959 FORT CAROLINE RD APT 3102
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City | JACKSONVILLE
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State | FL
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Zip | 32277-1863
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Country | US
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Telephone | 850-510-9142
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 9334560
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN9334560
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License Number State | FL
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