=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740881416
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONALD DOUGLASS JAMIESON
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2020
-----------------------------------------------------
Last Update Date | 11/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17929 HUNTING BOW CIR # NA
-----------------------------------------------------
City | LUTZ
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33558-5378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-792-8555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12424 SAULSTON PL
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34669-5009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-808-3352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F07200826
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------