MEDICARE: MRS. JACKY POMPONIO 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	363L00000X	Nurse Practitioner	ARNP749662	FL

General Provider Information

NPI Number	:	1417960683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACKY POMPONIO ARNP

Provider Business Mailing Address
First Line	:	1500 E HILLSBORO BLVD
Second Line	:	SUITE 107
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4355
Country	:	US
Telephone Number	:	954-428-1771
Fax Number	:	954-422-9538

Provider Business Practice Location Address
First Line	:	1500 E HILLSBORO BLVD
Second Line	:	SUITE 107
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33441-4355
Country	:	US
Telephone Number	:	954-428-1771
Fax Number	:	954-422-9538

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	10/11/2012

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