MEDICARE: JANET V ATTLESEY MD PA

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	207Q00000X	Family Medicine Physician	ME0071470	FL

General Provider Information

NPI Number	:	1619293347
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANET V ATTLESEY MD PA

Provider Business Mailing Address
First Line	:	751 SHIPWATCH DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5416
Country	:	US
Telephone Number	:	904-221-3394
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 SHIPWATCH DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5416
Country	:	US
Telephone Number	:	904-221-3394
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JANET VERGO ATTLESEY
Credential	:	M.D.
Telephone Number	:	904-221-3394

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	05/28/2010

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