MEDICARE: JAYSON SHANE LEDFORD RN

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	163W00000X	Registered Nurse	RN95991102	FL

General Provider Information

NPI Number	:	1396458501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYSON SHANE LEDFORD RN

Provider Business Mailing Address
First Line	:	3101 PORT ROYALE BLVD APT 1034
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-7920
Country	:	US
Telephone Number	:	786-879-9617
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 PORT ROYALE BLVD APT 1034
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-7920
Country	:	US
Telephone Number	:	786-879-9617
Fax Number	:

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

Provider Enumeration Date	:	01/03/2023
Last Update Date	:	01/03/2023

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