Provider Demographics
NPI:1366769721
Name:MCARTHUR, JEREMIAH DANIEL (APRN)
Entity type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:DANIEL
Last Name:MCARTHUR
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 1:2417 DAKOTA ROCK DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-6387
Mailing Address - Country:US
Mailing Address - Phone:910-545-6006
Mailing Address - Fax:401-841-6292
Practice Address - Street 1:119 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-4596
Practice Address - Country:US
Practice Address - Phone:781-885-6864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2341878163W00000X
1710I1002X
FL11015496363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman