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General NPI Number Information
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NPI Number | 1689030678
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Entity Type | Individual
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Provider Name | JAKE MCHARGUE
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Gender | Male
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 1031 E OAK ST
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City | ARCADIA
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State | FL
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Zip | 34266-8923
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Country | US
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Telephone | 863-491-7580
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Fax | 863-491-7584
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Provider Business Mailing Address
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Address Line | 34 S BALDWIN AVE
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City | ARCADIA
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State | FL
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Zip | 34266-3387
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Country | US
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Telephone | 863-491-7580
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Fax | 863-491-7584
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN5221889
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License Number State | FL
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