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General NPI Number Information
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NPI Number | 1104516491
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Entity Type | Individual
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Provider Name | JAE WON LIM LAYUG
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Gender | Female
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 405 LIONEL WAY
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City | DAVENPORT
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State | FL
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Zip | 33837-7811
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Country | US
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Telephone | 863-353-1390
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Fax | 863-438-4880
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Provider Business Mailing Address
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Address Line | 405 LIONEL WAY
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City | DAVENPORT
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State | FL
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Zip | 33837-7811
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Country | US
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Telephone | 863-353-1390
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Fax | 863-438-4880
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 11026214
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 11026214
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License Number State | FL
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