Healthcare Provider Details

I. General information

NPI: 1780256818
Provider Name (Legal Business Name): JENNIE MARIE DUBOSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 NE 60TH LN
OCALA FL
34479-1848
US

IV. Provider business mailing address

2635 NE 60TH LN
OCALA FL
34479-1848
US

V. Phone/Fax

Practice location:
  • Phone: 352-207-3283
  • Fax:
Mailing address:
  • Phone: 352-207-3283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9455519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: