=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255781696
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOCELYN DOINA ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2016
-----------------------------------------------------
Last Update Date | 07/27/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11050 MOUNT BELVEDERE BLVD
-----------------------------------------------------
City | FORT DRUM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13602-5438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-775-8763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 727 MILWAUKEE AVE APT 4
-----------------------------------------------------
City | DUNEDIN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34698-7148
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AL3858
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------