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General NPI Number Information
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NPI Number | 1093448102
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Entity Type | Organization
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Legal Business Name | INCHARGECLINIC
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 12250 BLUE PACIFIC DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-1803
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Country | US
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Telephone | 813-955-9734
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Fax | 813-366-8789
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Provider Business Mailing Address
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Address Line | 12250 BLUE PACIFIC DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-1803
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Country | US
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Telephone |
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Fax | 813-336-8789
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Authorized Official
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Title or Position | MMGR
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Name | JILL MARSHALL-ALLEN
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Credential | APRN CWS FACCWS
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Telephone | 813-530-9666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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