Provider Demographics
NPI:1952392045
Name:BOSWORTH, VERONICA ANN (ARNP)
Entity Type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:ANN
Last Name:BOSWORTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:ANN
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4500 SAN PABLO RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1865
Mailing Address - Country:US
Mailing Address - Phone:904-953-2000
Mailing Address - Fax:
Practice Address - Street 1:701 N STATE OF FRANKLIN RD STE 2
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3645
Practice Address - Country:US
Practice Address - Phone:423-926-4468
Practice Address - Fax:423-928-4838
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21076363L00000X
FLARNP2892522363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305839500Medicaid
FL305839500Medicaid