Provider Demographics
NPI:1457771016
Name:SURRENCY, GERRY (PMHNP-BC, ARNP)
Entity Type:Individual
Prefix:MR
First Name:GERRY
Middle Name:
Last Name:SURRENCY
Suffix:
Gender:M
Credentials:PMHNP-BC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 KINGSLEY AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4453
Mailing Address - Country:US
Mailing Address - Phone:904-300-4341
Mailing Address - Fax:
Practice Address - Street 1:1895 KINGSLEY AVE STE 403
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4453
Practice Address - Country:US
Practice Address - Phone:904-300-4341
Practice Address - Fax:904-300-4341
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3174792363LP0808X
FLARNP3174792363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health