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General NPI Number Information
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NPI Number | 1144539693
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Entity Type | Organization
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Legal Business Name | SPAULDING MEDICAL INC
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 16901 SW 76TH AVE
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City | PALMETTO BAY
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State | FL
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Zip | 33157-4802
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Country | US
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Telephone | 305-790-3108
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Fax |
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Provider Business Mailing Address
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Address Line | 16901 SW 76TH AVE
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City | PALMETTO BAY
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State | FL
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Zip | 33157-4802
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Country | US
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Telephone | 305-790-3108
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JODI SPAULDING
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Credential | ARNP
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Telephone | 305-790-3108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP2810642
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License Number State | FL
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