Healthcare Provider Details

I. General information

NPI: 1619891835
Provider Name (Legal Business Name): ALFRED JOSEPH JARVIS JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10100 MORNING MIST LN
SARASOTA FL
34241-1509
US

IV. Provider business mailing address

10100 MORNING MIST LN
SARASOTA FL
34241-1509
US

V. Phone/Fax

Practice location:
  • Phone: 203-247-4983
  • Fax:
Mailing address:
  • Phone: 203-247-4983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: