Healthcare Provider Details

I. General information

NPI: 1144418666
Provider Name (Legal Business Name): JARQUIN FAMILY PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N SCENIC HWY
FROSTPROOF FL
33843
US

IV. Provider business mailing address

205 N SCENIC HWY
FROSTPROOF FL
33843
US

V. Phone/Fax

Practice location:
  • Phone: 863-635-4100
  • Fax: 863-635-4499
Mailing address:
  • Phone: 863-635-4100
  • Fax: 863-635-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME78476
License Number StateFL

VIII. Authorized Official

Name: ALVARO JOSE JARQUIN
Title or Position: DR
Credential: MD
Phone: 863-635-4100