Healthcare Provider Details

I. General information

NPI: 1033978648
Provider Name (Legal Business Name): JAMIE FLYTHE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 N OAK ST BLDG C2
VALDOSTA GA
31602-1795
US

IV. Provider business mailing address

13364 BEACH BLVD UNIT 409
JACKSONVILLE FL
32224-0266
US

V. Phone/Fax

Practice location:
  • Phone: 229-474-6933
  • Fax: 888-815-1851
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN291974
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number9582156
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11032352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: