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General NPI Number Information
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NPI Number | 1356904353
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Entity Type | Organization
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Legal Business Name | MAGNOLIA FAMILY CARE CORP
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Dates
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Enumeration Date | 04/16/2019
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 256 SW PROFESSIONAL GLN STE 102
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City | LAKE CITY
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State | FL
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Zip | 32025-1104
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Country | US
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Telephone | 386-319-8938
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Fax | 386-438-8628
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Provider Business Mailing Address
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Address Line | 256 SW PROFESSIONAL GLN STE 102
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City | LAKE CITY
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State | FL
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Zip | 32025-1104
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Country | US
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Telephone | 386-319-8938
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Fax | 386-438-8628
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER LYN BRYAN
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Credential | DNP
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Telephone | 386-319-8938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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