Healthcare Provider Details

I. General information

NPI: 1255108080
Provider Name (Legal Business Name): JEFFERY SCOTT ARRENDALE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 12TH AVE
INDIAN ROCKS BEACH FL
33785-2854
US

IV. Provider business mailing address

393 12TH AVE
INDIAN ROCKS BEACH FL
33785-2854
US

V. Phone/Fax

Practice location:
  • Phone: 727-608-7918
  • Fax:
Mailing address:
  • Phone: 727-608-7918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number12591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: