MEDICARE: MRS. JANICE JEFFERSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1053860759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANICE JEFFERSON RN

Provider Business Mailing Address
First Line	:	2423 HIGHWAY 17 S OFC 11
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-4343
Country	:	US
Telephone Number	:	347-675-9812
Fax Number	:

Provider Business Practice Location Address
First Line	:	2423 HIGHWAY 17 S
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-4343
Country	:	US
Telephone Number	:	917-627-4903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	01/16/2026

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