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NPI Code Detail

MEDICARE: JACQUELYN ANDERSON

MEDICARE: JACQUELYN ANDERSON
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1891278149
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN ANDERSON
Provider Business Mailing Address
First Line : 325 SW 28TH ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33315-2612
Country : US
Telephone Number : 954-357-4843
Fax Number :
Provider Business Practice Location Address
First Line : 325 SW 28TH ST
Second Line :
City : FORT LAUDERDALE
State : FL
Zip : 33315-2612
Country : US
Telephone Number : 954-357-4843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2018
Last Update Date : 09/12/2018

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Directions to “ JACQUELYN ANDERSON ” Practice Location

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