Provider Demographics
NPI:1508398181
Name:HANCOCK, AUTUMN (APRN)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUTUMN MCBETH
Mailing Address - Street 1:2161 KINGSLEY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5116
Mailing Address - Country:US
Mailing Address - Phone:904-276-2303
Mailing Address - Fax:
Practice Address - Street 1:2161 KINGSLEY AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5116
Practice Address - Country:US
Practice Address - Phone:904-276-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-01
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9252329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily