Healthcare Provider Details

I. General information

NPI: 1104093459
Provider Name (Legal Business Name): JODIE KAYE COTRELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

328 SW THORNE LN
FORT WHITE FL
32038-2150
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-5114
  • Fax:
Mailing address:
  • Phone: 386-454-8963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR87215
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN 9261034
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1105484
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041350284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: