Provider Demographics
NPI:1508398181
Name:HANCOCK, AUTUMN M (APRN)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:M
Last Name:HANCOCK
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:AUTUMN
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AUTUMN MCBETH
Mailing Address - Street 1:7015 A C SKINNER PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6932
Mailing Address - Country:US
Mailing Address - Phone:904-363-7453
Mailing Address - Fax:
Practice Address - Street 1:700 3RD ST STE 302
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5082
Practice Address - Country:US
Practice Address - Phone:904-997-3800
Practice Address - Fax:904-997-3899
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9252329363L00000X
FL9252329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily