Healthcare Provider Details

I. General information

NPI: 1982244661
Provider Name (Legal Business Name): JENNIFER JUNE CLINE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36435 RANCH RD
EUSTIS FL
32736-8411
US

IV. Provider business mailing address

36435 RANCH RD
EUSTIS FL
32736-8411
US

V. Phone/Fax

Practice location:
  • Phone: 352-406-7599
  • Fax:
Mailing address:
  • Phone: 352-406-7599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11005120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: