MEDICARE: ROBERT JASON EPPERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	11013999	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417690132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JASON EPPERSON

Provider Business Mailing Address
First Line	:	4801 NW GIMLET AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1336
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4801 NW GIMLET AVE
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34983-1336
Country	:	US
Telephone Number	:	407-729-4835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2022
Last Update Date	:	04/20/2022

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