Healthcare Provider Details

I. General information

NPI: 1073360160
Provider Name (Legal Business Name): JCT PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 NW MADISON RD
MAYO FL
32066-3777
US

IV. Provider business mailing address

437 NW MADISON RD
MAYO FL
32066-3777
US

V. Phone/Fax

Practice location:
  • Phone: 386-209-8723
  • Fax: 386-935-4331
Mailing address:
  • Phone: 386-209-8723
  • Fax: 386-935-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHRISTINA N THOMAS
Title or Position: OWNER
Credential: APRN
Phone: 386-209-8723