Healthcare Provider Details

I. General information

NPI: 1417563602
Provider Name (Legal Business Name): JEILA STEPHANIE PUJOLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 01/11/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MEDICAL CENTER AVE
SEBRING FL
33870-5463
US

IV. Provider business mailing address

130 MEDICAL CENTER AVE
SEBRING FL
33870-5463
US

V. Phone/Fax

Practice location:
  • Phone: 863-385-2606
  • Fax:
Mailing address:
  • Phone: 863-385-2606
  • Fax: 863-385-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11010916
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: