Provider Demographics
NPI:1104286863
Name:PROPST, JODY KRISTIN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:KRISTIN
Last Name:PROPST
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:KRISTIN
Other - Last Name:WETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2800 UNIVERSITY BLVD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-3394
Mailing Address - Country:US
Mailing Address - Phone:904-256-8000
Mailing Address - Fax:
Practice Address - Street 1:5491 DOLPHIN POINT BLVD STE 1300
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-3221
Practice Address - Country:US
Practice Address - Phone:904-256-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9320843363L00000X
FL9320843363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017162800Medicaid