Provider Demographics
NPI:1366752842
Name:OPDYCKE, EMILY (APRN)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:OPDYCKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8149 POINT MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9111
Mailing Address - Country:US
Mailing Address - Phone:904-260-0352
Mailing Address - Fax:904-363-9818
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2497
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7420
Practice Address - Country:US
Practice Address - Phone:904-260-0352
Practice Address - Fax:904-260-0353
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9479682363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024227900Medicaid
FL359903OtherAVMED
FL9677959OtherAETNA
FLY0E8GOtherBCBS FL