Healthcare Provider Details

I. General information

NPI: 1285048298
Provider Name (Legal Business Name): HEATHER JIPSON RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19468 BERMUDA CT
NORTH FORT MYERS FL
33903-6657
US

IV. Provider business mailing address

19468 BERMUDA CT
NORTH FORT MYERS FL
33903-6657
US

V. Phone/Fax

Practice location:
  • Phone: 443-622-7129
  • Fax:
Mailing address:
  • Phone: 443-622-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT13172
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: