Basic Information
| Provider Information | |||||||||
| NPI: | 1417100686 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERSON | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | GORDON | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ARNP, CPNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 MAJESTIC EAGLE DR | ||||||||
| Address2: | |||||||||
| City: | PONTE VEDRA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320810617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048615251 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 PRUDENTIAL DR | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042028000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2008 | ||||||||
| LastUpdateDate: | 09/02/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | ARNP 9217717 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 012173500 | 05 | FL | MEDICAID | 003149493A | 05 | GA | MEDICAID |