Healthcare Provider Details

I. General information

NPI: 1942270905
Provider Name (Legal Business Name): E & M MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10383 HAMPTON AVE
STARKE FL
32091-7843
US

IV. Provider business mailing address

10383 HAMPTON AVE
STARKE FL
32091-7843
US

V. Phone/Fax

Practice location:
  • Phone: 352-468-1735
  • Fax: 352-468-1739
Mailing address:
  • Phone: 352-468-1735
  • Fax: 352-468-1739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS0006902
License Number StateFL

VIII. Authorized Official

Name: DR. JOELLE M INNOCENT-SIMON
Title or Position: MEDICAL DOCTOR
Credential: D.O.
Phone: 352-468-1735