MEDICARE: JACOB BARD

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	163W00000X	Registered Nurse	RN9491993	FL

General Provider Information

NPI Number	:	1487241782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB BARD

Provider Business Mailing Address
First Line	:	3909 N OCEAN BLVD APT 416
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6447
Country	:	US
Telephone Number	:	718-757-2794
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 N OCEAN BLVD APT 416
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-6447
Country	:	US
Telephone Number	:	718-757-2794
Fax Number	:

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

Provider Enumeration Date	:	12/22/2020
Last Update Date	:	12/22/2020

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Directions to “ JACOB BARD ” Practice Location

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