Healthcare Provider Details

I. General information

NPI: 1447924584
Provider Name (Legal Business Name): ANESTHESIOLOGY OF JUPITER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 MILITARY TRL
JUPITER FL
33458-7801
US

IV. Provider business mailing address

PO BOX 744069 DEPT 50012
ATLANTA GA
30384-4069
US

V. Phone/Fax

Practice location:
  • Phone: 877-328-1119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: MANAGING EMPLOYEE
Credential:
Phone: 404-450-4684