Provider Demographics
NPI:1013349604
Name:JARRELL, KERRI COPELAND (ARPN)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:COPELAND
Last Name:JARRELL
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-0756
Mailing Address - Country:US
Mailing Address - Phone:904-262-9075
Mailing Address - Fax:904-262-9076
Practice Address - Street 1:11701 SAN JOSE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-0756
Practice Address - Country:US
Practice Address - Phone:904-262-9075
Practice Address - Fax:904-262-9076
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9294200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily