Healthcare Provider Details

I. General information

NPI: 1477174712
Provider Name (Legal Business Name): JEFFREY MARK PLANTE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NW 89TH BLVD RM 1796
GAINESVILLE FL
32606-3813
US

IV. Provider business mailing address

1616 PHYSICIANS DR
TALLAHASSEE FL
32308-4619
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-2863
  • Fax:
Mailing address:
  • Phone: 850-431-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS18752
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: