Healthcare Provider Details

I. General information

NPI: 1679402176
Provider Name (Legal Business Name): JEEVA GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD
GAINESVILLE FL
32610-3450
US

IV. Provider business mailing address

1729 E AZTEC LN,
MT PROSPECT IL
60056
US

V. Phone/Fax

Practice location:
  • Phone: 224-727-9846
  • Fax:
Mailing address:
  • Phone: 224-727-9846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: