MEDICARE: MRS. JESSICA LAYNE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255864773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LAYNE

Provider Business Mailing Address
First Line	:	741 W COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-7343
Country	:	US
Telephone Number	:	407-843-1760
Fax Number	:	407-843-1760

Provider Business Practice Location Address
First Line	:	4400 N HIGHWAY 19A
Second Line	:	UNIT 10
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-2032
Country	:	US
Telephone Number	:	407-843-1760
Fax Number	:	407-843-1767

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/11/2017

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Directions to “ MRS. JESSICA LAYNE ” Practice Location

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