Healthcare Provider Details

I. General information

NPI: 1487674529
Provider Name (Legal Business Name): JACKIE C WHITE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 SE 1ST AVE 101
OCALA FL
34471-0409
US

IV. Provider business mailing address

2801 SE 1ST AVE 101
OCALA FL
34471-0409
US

V. Phone/Fax

Practice location:
  • Phone: 352-690-6300
  • Fax: 352-690-6802
Mailing address:
  • Phone: 352-690-6300
  • Fax: 352-690-6802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9189802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: