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NPI Code Detail

MEDICARE: MS. JACQUELYN BOBERG APRN

MEDICARE: MS. JACQUELYN BOBERG 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
1363LF0000XFamily Nurse PractitionerARNP9345316FL
2363LF0000XFamily Nurse PractitionerAPRN9345316FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235611286
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELYN BOBERG APRN
Provider Business Mailing Address
First Line : 1561 GRACE AVE
Second Line :
City : FORT MYERS
State : FL
Zip : 33901-6832
Country : US
Telephone Number : 239-440-9404
Fax Number :
Provider Business Practice Location Address
First Line : 737 CAPE CORAL PKWY E
Second Line :
City : CAPE CORAL
State : FL
Zip : 33904-8551
Country : US
Telephone Number : 239-542-0512
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2018
Last Update Date : 05/18/2026

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