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4264 Avalon Blvd Milton FL 32583-2808 | |
| (850) 994-0431 | |
| (850) 994-7883 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 4264 Avalon Blvd, Milton, 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 |
|---|---|
Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7211 | 4264 Avalon Blvd Milton FL 32583-2808 Ph: (850) 994-0431 |
| NPI Number | 1972170785 |
|---|---|
| Provider Enumeration Date | 06/09/2021 |
| Last Update Date | 03/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972170785 | NPI | - | NPPES |
| 374819726 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
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