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General NPI Number Information
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NPI Number | 1447029632
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Entity Type | Organization
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Legal Business Name | JR MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/28/2023
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 13162 US HIGHWAY 301 S
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City | RIVERVIEW
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State | FL
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Zip | 33578-7410
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Country | US
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Telephone | 813-850-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 E LUMSDEN RD
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City | BRANDON
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State | FL
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Zip | 33511-6727
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NP
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Name | RAJI KURIAKOSE
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Credential |
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Telephone | 813-850-3004
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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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