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2446 Laurel Rd E North Venice FL 34275-3204 | |
(941) 218-6200 | |
(941) 218-6182 |
Full Name | |
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Speciality | Family Medicine |
Location | 2446 Laurel Rd E, North Venice, Florida |
Authorized Official Name and Position | Jennifer L Jackson (SR DIR PROV ENROLLMENT & ONBOARDING) |
Authorized Official Contact | 6154653334 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | 2446 Laurel Rd E North Venice FL 34275-3204 Ph: (941) 218-6200 |
NPI Number | 1518535137 |
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Provider Enumeration Date | 06/11/2021 |
Last Update Date | 03/15/2022 |
Identifier | Type | State | Issuer |
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1518535137 | NPI | - | NPPES |
277033444 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |