Provider Demographics
NPI:1508950072
Name:REESER, ANNE TERESA HESSON (ARNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:TERESA HESSON
Last Name:REESER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-483-5826
Mailing Address - Fax:904-265-6409
Practice Address - Street 1:1883 KINGSLEY AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4479
Practice Address - Country:US
Practice Address - Phone:904-264-9797
Practice Address - Fax:904-264-4644
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900067363L00000X
FLARNP9329975363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006455500Medicaid
FL006455500Medicaid