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General NPI Number Information
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NPI Number | 1245840495
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Entity Type | Individual
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Provider Name | ROBERT M JERNIGAN JR. M.A. CAP
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Gender | Male
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 820 37TH PL
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City | VERO BEACH
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State | FL
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Zip | 32960-6562
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Country | US
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Telephone | 772-569-9788
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Fax | 772-569-2088
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Provider Business Mailing Address
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Address Line | 1918 ESPLANADE AVE N
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City | FORT PIERCE
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State | FL
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Zip | 34982-5647
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Country | US
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Telephone | 772-672-0412
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH19742
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License Number State | FL
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