Provider Demographics
NPI:1861853087
Name:FIELDS, JERLESHIA ANNETTA (ARNP-BC)
Entity Type:Individual
Prefix:
First Name:JERLESHIA
Middle Name:ANNETTA
Last Name:FIELDS
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:JERLESHIA
Other - Middle Name:ANNETTA
Other - Last Name:GILBERT-FIELDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:2525 REAGAN LAKES LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3815
Mailing Address - Country:US
Mailing Address - Phone:904-504-2319
Mailing Address - Fax:
Practice Address - Street 1:3002 N MYRTLE AVE STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-4228
Practice Address - Country:US
Practice Address - Phone:904-355-5855
Practice Address - Fax:904-355-2011
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9187114363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily