Healthcare Provider Details

I. General information

NPI: 1750204657
Provider Name (Legal Business Name): JACOB MATTHEW ENO APRN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 SW 20TH PL
OCALA FL
34471-7734
US

IV. Provider business mailing address

2111 SW 20TH PL
OCALA FL
34471-7734
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4251
  • Fax: 352-622-0102
Mailing address:
  • Phone: 352-622-4251
  • Fax: 352-622-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: