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NPI Code Detail

MEDICARE: ANDREW DAVID GREEN ARNP

MEDICARE: ANDREW DAVID GREEN ARNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerARNP9176315FL

General Provider Information

NPI Number : 1396007993
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREW DAVID GREEN ARNP
Provider Business Mailing Address
First Line : 2023 MYRA ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-3714
Country : US
Telephone Number : 904-503-5464
Fax Number : 904-575-4399
Provider Business Practice Location Address
First Line : 2023 MYRA ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-3714
Country : US
Telephone Number : 904-503-5464
Fax Number : 904-575-4399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2012
Last Update Date : 09/11/2023

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