Individual
LACY DANIELLE GULLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
15255 MAX LEGGETT PKWY, JACKSONVILLE, FL 32218-7273
(904) 244-0411
Mailing address
75338 RAVENWOOD DR, YULEE, FL 32097-1609
(334) 208-6190
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
ARNP9429348
FL
363LG0600X
Gerontology Nurse Practitioner
Primary
ARNP9429348
FL
Other
Enumeration date
10/23/2017
Last updated
01/30/2018
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