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General NPI Number Information
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NPI Number | 1386408706
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Entity Type | Organization
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Legal Business Name | BLUEROCK MEDICAL LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 810 N RIDGEWOOD DR
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City | SEBRING
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State | FL
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Zip | 33870-7217
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Country | US
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Telephone | 863-873-0072
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Fax |
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Provider Business Mailing Address
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Address Line | 505 SUMMIT DR
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City | SEBRING
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State | FL
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Zip | 33870-2341
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Country | US
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Telephone | 863-873-0072
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIE LECLAIR SPENCER
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Credential | DNP, APRN, FNP-C
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Telephone | 863-873-0072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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