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General NPI Number Information
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NPI Number | 1942803861
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Entity Type | Individual
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Provider Name | WILLIAM ROBERT MICKLE APRN
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Gender | Male
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Dates
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Enumeration Date | 11/21/2020
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Last Update Date | 11/06/2022
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Provider Practice Location Address
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Address Line | 655 W 8TH ST
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City | JACKSONVILLE
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State | FL
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Zip | 32209-6511
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Country | US
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Telephone | 904-244-8649
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Fax |
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Provider Business Mailing Address
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Address Line | 986 STOCKS ST
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-2560
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Country | US
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Telephone | 210-589-0491
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN11022369
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 9372941
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License Number State | FL
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