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General NPI Number Information
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NPI Number | 1669481008
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Entity Type | Organization
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Legal Business Name | JACKSON HEALTH SYSTEM
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 9771 GLACIER DR
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City | MIRAMAR
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State | FL
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Zip | 33025-4410
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Country | US
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Telephone | 954-554-6416
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Fax |
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Provider Business Mailing Address
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Address Line | 9771 GLACIER DR
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City | MIRAMAR
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State | FL
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Zip | 33025-4410
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Country | US
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Telephone | 954-554-6416
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Fax |
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Authorized Official
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Title or Position | ARNP
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Name | MRS. DAPHNE LEONIE REYNOLDS
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Credential | ARNP
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Telephone | 786-263-4935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1706182
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License Number State | FL
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