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General NPI Number Information
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NPI Number | 1053969014
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Entity Type | Individual
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Provider Name | JURRY OM FNP
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 707 W EAU GALLIE BLVD
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City | MELBOURNE
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State | FL
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Zip | 32935-5958
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Country | US
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Telephone | 321-727-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 8880 NAPOLO DR
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City | MELBOURNE
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State | FL
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Zip | 32940-7499
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Country | US
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Telephone | 303-501-2800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | MO9002990
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN.0994708-NP
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11032788
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License Number State | FL
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