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General NPI Number Information
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NPI Number | 1891492831
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Entity Type | Individual
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Provider Name | BENJAMIN SETH CANNON
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Gender | Male
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Dates
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Enumeration Date | 02/09/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 1 SHIRCLIFF WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32204-4748
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Country | US
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Telephone | 904-308-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 543 KENDALL CROSSING DR
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City | ST JOHNS
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State | FL
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Zip | 32259-8766
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Country | US
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Telephone | 904-521-9796
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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 | APRN11024408
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License Number State | FL
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