MEDICARE: FLORIDA DEPARTMENT OF VETERANS AFFAIRS

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	314000000X	Skilled Nursing Facility		FL
2	311500000X	Alzheimer Center (Dementia Center)		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M4J	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629060272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA DEPARTMENT OF VETERANS AFFAIRS

Provider Business Mailing Address
First Line	:	21281 GRAYTON TER
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-3109
Country	:	US
Telephone Number	:	941-613-0919
Fax Number	:	941-613-0935

Provider Business Practice Location Address
First Line	:	21281 GRAYTON TER
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33954-3109
Country	:	US
Telephone Number	:	941-613-0919
Fax Number	:	941-613-0935

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. WILLIAM G PUCKETT
Credential	:
Telephone Number	:	727-518-3202

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	09/11/2025

Similar Medicare Providers

1023005741 — DR. MARY VIRGINIA CAPUTI PHARMD
Practice Location Address:

21281 GRAYTON TER , DOUGLAS T. JACOBSON STATE VETERANS NURSING HOME
PORT CHARLOTTE, FL
33954-3109

Practice Phone: 941-235-2710
Practice Fax:

1922060904 — MRS. LINDA BARBARA LEE-BARDOWSKI MS, ARNP-C
Practice Location Address:

21281 GRAYTON TER
PORT CHARLOTTE, FL
33954-3109

Practice Phone: 941-235-2710
Practice Fax:

1336238468 — MRS. MARIE MAY BEADLE PHARMD
Practice Location Address:

21281 GRAYTON TER
PORT CHARLOTTE, FL
33954-3109

Practice Phone: 941-613-0919
Practice Fax:

1932366689 — MS. KRISTEN MARIE BOWMAN DPT
Practice Location Address:

21281 GRAYTON TER
PORT CHARLOTTE, FL
33954-3109

Practice Phone: 619-585-4080
Practice Fax:

1750788287 — MRS. VICKIE SHUFFITT P.T.
Practice Location Address:

21281 GRAYTON TER , DOUGLAS T JACOBSON VETERANS HOME
PORT CHARLOTTE, FL
33954-3109

Practice Phone: 941-613-0919
Practice Fax:

1336521673 — CALLMAN INTERNAL MEDICINE
Practice Location Address:

21281 GRAYTON TER , D JACOBSON VA NH
PORT CHARLOTTE, FL
33954-3109

Practice Phone: 941-206-5200
Practice Fax:

Directions to “FLORIDA DEPARTMENT OF VETERANS AFFAIRS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.