Provider Demographics
NPI:1164911913
Name:POOVEY, ERIC LANG (ARNP)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LANG
Last Name:POOVEY
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6118 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-3949
Mailing Address - Country:US
Mailing Address - Phone:904-994-0429
Mailing Address - Fax:
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2317
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7418
Practice Address - Country:US
Practice Address - Phone:904-202-2342
Practice Address - Fax:904-376-3328
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3367362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner