Provider Demographics
NPI:1710631486
Name:DREXEL, CEARA (NP)
Entity Type:Individual
Prefix:
First Name:CEARA
Middle Name:
Last Name:DREXEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 PARK ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4520
Mailing Address - Country:US
Mailing Address - Phone:904-388-4646
Mailing Address - Fax:904-388-9017
Practice Address - Street 1:2606 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4520
Practice Address - Country:US
Practice Address - Phone:904-388-4646
Practice Address - Fax:904-388-9017
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11089015208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics