MEDICARE: DR. JEAN H AERTKER DNP, ARNP

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	363LX0106X	Occupational Health Nurse Practitioner	1065822	FL

General Provider Information

NPI Number	:	1295732311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN H AERTKER DNP, ARNP

Provider Business Mailing Address
First Line	:	2919 WEST SWANN AVENUE
Second Line	:	SUITE 402
City	:	TAMPA
State	:	FL
Zip	:	33609
Country	:	US
Telephone Number	:	813-414-9400
Fax Number	:	813-414-9401

Provider Business Practice Location Address
First Line	:	2919 W SWANN AVE
Second Line	:	SUITE 402
City	:	TAMPA
State	:	FL
Zip	:	33609-4038
Country	:	US
Telephone Number	:	813-414-9400
Fax Number	:	813-414-9401

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/06/2010

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