Georgette Louise Provost-Dukes, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

ARNP9168198 Issued in FL

Practice address

4241 Baymeadows Rd Ste 6
Jacksonville, FL 32217-4673

Phone

(407) 719-5723

NPI assigned

Mar 22, 2018

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lillys Medical Center LLC

  • Primary Care Nurse Practitioner
  • Jacksonville, FL
  • NPI 1063007854

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614816000000",
    "number": "1689178667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 WHITE HERON TRL",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320731644",
            "telephone_number": "407-719-5723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4241 BAYMEADOWS RD STE 6",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174673",
            "telephone_number": "407-719-5723"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3110 White Heron Trl",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320731644",
            "country_code": "US",
            "telephone_number": "407-719-5723",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVOST-DUKES",
        "first_name": "GEORGETTE",
        "middle_name": "LOUISE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-03-22",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "ARNP9168198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Provenzano Counseling Services
• Liza Cristin Provenzano, LMHC
• Paul David Provenzano, DPT
• Providential Health Care, Inc
• Aimee Lynn Provo, BS
• Jacob Prows
• Charles Howell Pruden IV, MD
• Kathryn Pruden, MD
• Ma. Concepcion Mendoza Prudencio, MD
• Allie Pruett, PT, DPT

• Family Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.