Healthcare Provider Details

I. General information

NPI: 1699281881
Provider Name (Legal Business Name): JOWELL MONROE HEARN IV RN RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/25/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17240 CORTEZ BLVD
BROOKSVILLE FL
34601-8921
US

IV. Provider business mailing address

922 CEDAR DR
BROOKSVILLE FL
34601-2213
US

V. Phone/Fax

Practice location:
  • Phone: 352-544-6015
  • Fax: 352-754-3282
Mailing address:
  • Phone: 352-232-0089
  • Fax: 352-754-3282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number3288952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: