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General NPI Number Information
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NPI Number | 1659963981
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Entity Type | Individual
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Provider Name | ALYSHA MARINA DEGROVE DNP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 2080 CHILD ST
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City | JACKSONVILLE
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State | FL
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Zip | 32214-5005
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Country | US
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Telephone | 904-542-7640
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Fax |
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Provider Business Mailing Address
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Address Line | 85001 CREWS RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-1557
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Country | US
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Telephone | 904-307-5724
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11013662
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | RN9192330
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License Number State | FL
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