Healthcare Provider Details

I. General information

NPI: 1639596596
Provider Name (Legal Business Name): MYRA JAMMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SW 13TH STREET
GAINESVILLE FL
32608
US

IV. Provider business mailing address

545 NW 39TH DR
GAINESVILLE FL
32607-4807
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5600
  • Fax:
Mailing address:
  • Phone: 352-336-2844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 2739012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: