=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851851554
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VERONICA H BARTLEY APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2019
-----------------------------------------------------
Last Update Date | 08/08/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 819 TOWNSEND BLVD
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32211-6132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-374-3311
-----------------------------------------------------
Fax | 904-374-3338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15319 SPOTTED STALLION TRL
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32234-2397
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-294-6985
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 11001870
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11001870
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------