=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538614888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JODI LEVINS ARNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2016
-----------------------------------------------------
Last Update Date | 08/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 737 WATERBRIDGE DR
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33880-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-412-1254
-----------------------------------------------------
Fax | 863-297-8069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 737 WATERBRIDGE DR
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33880-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-412-1254
-----------------------------------------------------
Fax | 863-297-8069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9258228
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------