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1111 12th St Ste 205 Key West FL 33040-3001 | |
| (615) 465-7211 | |
| (615) 628-6877 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1111 12th St Ste 205, Key West, Florida |
| Authorized Official Name and Position | Jennifer L Jackson (SR DR PROV ENROLLMENT & ONBOARDING) |
| Authorized Official Contact | 6154653334 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1111 12th St Ste 205 Key West FL 33040-3001 Ph: (615) 465-7211 | 1111 12th St Ste 205 Key West FL 33040-3001 Ph: (615) 465-7211 |
| NPI Number | 1790472678 |
|---|---|
| Provider Enumeration Date | 04/20/2023 |
| Last Update Date | 06/16/2023 |
| Certification Date | 06/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790472678 | NPI | - | NPPES |
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