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General NPI Number Information
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NPI Number | 1780655373
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Entity Type | Organization
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Legal Business Name | NAVAL HOSPITAL JACKSONVILLE
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | NAVAL HOSPITAL JACKSONVILLE
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City | JACKSONVILLE
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State | FL
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Zip | 32214-0001
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Country | US
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Telephone | 904-542-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 631 MADERA RD
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City | CHESAPEAKE
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State | VA
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Zip | 23322-8048
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Country | US
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Telephone | 757-636-0296
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MRS. SHIRLEY LOUISE RUSSELL
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Credential | FNP
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Telephone | 904-542-7500
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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 | 0024000076
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License Number State | VA
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