MEDICARE: JACARANDA FAMILY MEDICINE P A

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DN3383	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174588586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JACARANDA FAMILY MEDICINE P A

Provider Business Mailing Address
First Line	:	4315 TAMIAMI TRL S
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-5117
Country	:	US
Telephone Number	:	941-497-4303
Fax Number	:	941-497-3107

Provider Business Practice Location Address
First Line	:	4315 TAMIAMI TRL S
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-5117
Country	:	US
Telephone Number	:	941-497-4303
Fax Number	:	941-497-3107

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHEN A. SOLLOTT
Credential	:	D.O.
Telephone Number	:	941-497-4303

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	09/29/2008

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Directions to “JACARANDA FAMILY MEDICINE P A ” Practice Location

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