=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760896161
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANNICE ALECIA RENAE BECKFORD M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2014
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9401 SW HIGHWAY 200 BLDG 90
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34481-9612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-671-2320
-----------------------------------------------------
Fax | 352-820-5690
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 CORPORATE WAY DOOR D
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33025-3925
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-276-5685
-----------------------------------------------------
Fax | 954-985-7074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | TRN 19938
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME129437
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------