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NPI Code Detail

MEDICARE: JANICE BAUCOM APRN

MEDICARE: JANICE BAUCOM APRN
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
1363L00000XNurse PractitionerARNP2051512FL
2363LF0000XFamily Nurse PractitionerARNP2051512FL

Other Identifiers

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

General Provider Information

NPI Number : 1194140319
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE BAUCOM APRN
Provider Business Mailing Address
First Line : 23476 NW 186TH AVE
Second Line :
City : HIGH SPRINGS
State : FL
Zip : 32643-0673
Country : US
Telephone Number : 386-454-0698
Fax Number : 386-454-0690
Provider Business Practice Location Address
First Line : 211 RANCHERA ST NW
Second Line :
City : LIVE OAK
State : FL
Zip : 32064-4866
Country : US
Telephone Number : 386-364-1751
Fax Number : 386-364-1761
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2014
Last Update Date : 01/14/2025

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