Healthcare Provider Details

I. General information

NPI: 1841791530
Provider Name (Legal Business Name): JAMIE PONTI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W INDIAN RIVER BLVD STE 2
EDGEWATER FL
32132-3500
US

IV. Provider business mailing address

602 W INDIAN RIVER BLVD
EDGEWATER FL
32132-3591
US

V. Phone/Fax

Practice location:
  • Phone: 386-868-2619
  • Fax:
Mailing address:
  • Phone: 386-868-2619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9314363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: