Provider Demographics
NPI:1871138263
Name:MCINNIS, SYDNEY (DNP, APRN)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 UNF DRIVE
Mailing Address - Street 2:BUILDING 2, ROOM 2300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 UNF DRIVE
Practice Address - Street 2:BUILDING 2, ROOM 2300
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224
Practice Address - Country:US
Practice Address - Phone:904-620-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-09
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9416704163W00000X
MN2478891163W00000X
MARN2362493163W00000X, 363LP0808X
NY864485163W00000X
MN7151363L00000X, 363LP0808X
NY404847363LP0808X
FLAPRN11003543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner