Individual
ANTHONY ATWOOD PREMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, AGACNP-BC
Contact information
Practice address
14785 OLD SAINT AUGUSTINE RD STE 100, JACKSONVILLE, FL 32258-7407
(904) 456-0017
(904) 456-0018
Mailing address
14785 OLD SAINT AUGUSTINE RD STE 100, JACKSONVILLE, FL 32258-7407
(904) 456-0017
(904) 456-0018
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN11020380
FL
363LA2100X
Acute Care Nurse Practitioner
APRN11020380
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11020380
FL
363LG0600X
Gerontology Nurse Practitioner
APRN11020380
FL
Other
Enumeration date
06/22/2022
Last updated
03/13/2025
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