Healthcare Provider Details

I. General information

NPI: 1841219086
Provider Name (Legal Business Name): JODI REPKO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SW 1ST AVE
OCALA FL
34474-4004
US

IV. Provider business mailing address

826 NE 12TH TER
OCALA FL
34470-6029
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-3407
  • Fax: 352-351-7602
Mailing address:
  • Phone: 352-368-9734
  • Fax: 727-507-3618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP3293312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: