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Individual

MS. JACQUELYN DANETTE CANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
11513 N MAIN ST, JACKSONVILLE, FL 32218-4002
(855) 674-7400
(904) 730-1037
Mailing address
2675 WINKLER AVE FL 2, FORT MYERS, FL 33901-9342
(877) 856-3774

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
APRN
NH
363LA2100X
Acute Care Nurse Practitioner
Primary
ARNP9169833
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0031120-00
FL
05
580304754A
GA
01
ARNP9169833
FLORIDA BOARD OF NUSING LICENSE #
FL
Enumeration date
04/22/2008
Last updated
08/20/2025
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