MEDICARE: JAMIE LYNNE VANAUKER 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
1	363L00000X	Nurse Practitioner	APRN9292413	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WN026	OTHER	FL	HFMG

General Provider Information

NPI Number	:	1417460692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LYNNE VANAUKER APRN

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-312-3321
Fax Number	:

Provider Business Practice Location Address
First Line	:	1223 GATEWAY DR
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-2607
Country	:	US
Telephone Number	:	321-312-3321
Fax Number	:	321-409-3685

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

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	12/08/2025

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