Provider Demographics
NPI:1326305608
Name:NORRIS, GREGORY ALAN JR (NP-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALAN
Last Name:NORRIS
Suffix:JR
Gender:M
Credentials:NP-C
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Mailing Address - Street 1:7807 BAYMEADOWS RD E STE 208
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9666
Mailing Address - Country:US
Mailing Address - Phone:904-330-0302
Mailing Address - Fax:904-330-0418
Practice Address - Street 1:7807 BAYMEADOWS RD E STE 208
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9666
Practice Address - Country:US
Practice Address - Phone:904-330-0302
Practice Address - Fax:904-330-0418
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9245001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005843600Medicaid
FL005843600Medicaid