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1447210257

NPI Code Detail

MEDICARE: MR. JEFFREY THOMAS SPENCER CRNA

MEDICARE: MR. JEFFREY THOMAS SPENCER CRNA

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	367500000X	Certified Registered Nurse Anesthetist	ARNP9173128	FL
2	367500000X	Certified Registered Nurse Anesthetist	APRN231221	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447210257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY THOMAS SPENCER CRNA

Provider Business Mailing Address
First Line	:	86648 RIVERWOOD DR
Second Line	:
City	:	YULEE
State	:	FL
Zip	:	32097-6446
Country	:	US
Telephone Number	:	904-307-5981
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 BELFORT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6004
Country	:	US
Telephone Number	:	904-483-5850
Fax Number	:	904-265-6409

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/11/2013

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Directions to “ MR. JEFFREY THOMAS SPENCER CRNA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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