Provider Demographics
NPI:1467132647
Name:KNAPP, DOUGLAS TERRY (APRN)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:TERRY
Last Name:KNAPP
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9889 GATE PKWY N STE 305
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-9230
Mailing Address - Country:US
Mailing Address - Phone:904-725-6463
Mailing Address - Fax:904-239-2349
Practice Address - Street 1:9889 GATE PKWY N STE 305
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-9230
Practice Address - Country:US
Practice Address - Phone:904-725-6463
Practice Address - Fax:904-239-2349
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027661363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health