MEDICARE: FEDERLIN JEAN

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	207R00000X	Internal Medicine Physician	ME159411	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	:	1962031740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FEDERLIN JEAN

Provider Business Mailing Address
First Line	:	8000 LEM TURNER RD # 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2758
Country	:	US
Telephone Number	:	904-539-8200
Fax Number	:	904-539-8229

Provider Business Practice Location Address
First Line	:	8000 LEM TURNER RD # 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2758
Country	:	US
Telephone Number	:	904-539-8200
Fax Number	:	904-539-8229

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

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	10/08/2024

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Directions to “ FEDERLIN JEAN ” Practice Location

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