Provider Demographics
NPI:1053069997
Name:CANNON, MINDY MCLEAN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:MCLEAN
Last Name:CANNON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 CREEK ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-7123
Mailing Address - Country:US
Mailing Address - Phone:904-238-8098
Mailing Address - Fax:
Practice Address - Street 1:8021 PHILIPS HWY STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7460
Practice Address - Country:US
Practice Address - Phone:904-323-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018350363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily