Healthcare Provider Details

I. General information

NPI: 1649634296
Provider Name (Legal Business Name): KEITH LEE JONES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NE SPANISH RIVER BLVD STE 102
BOCA RATON FL
33431-4500
US

IV. Provider business mailing address

500 NE SPANISH RIVER BLVD STE 102
BOCA RATON FL
33431-4500
US

V. Phone/Fax

Practice location:
  • Phone: 561-347-1112
  • Fax: 561-368-0459
Mailing address:
  • Phone: 561-347-1112
  • Fax: 561-368-0459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9195868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: