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NPI Code Detail

MEDICARE: JDPREMIUM HEALTHCARE, LLC

MEDICARE: JDPREMIUM HEALTHCARE, LLC
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
1163W00000XRegistered Nurse
2208D00000XGeneral Practice PhysicianME57721FL
3363LF0000XFamily Nurse PractitionerARNP9361683FL
4207Q00000XFamily Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number : 1538557608
Entity Type Code : Organization
Provider Name (Legal Business Name) : JDPREMIUM HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 14 W JORDAN ST STE 1J
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-1734
Country : US
Telephone Number : 850-455-1252
Fax Number : 844-683-8754
Provider Business Practice Location Address
First Line : 14 W JORDAN ST STE 1J
Second Line :
City : PENSACOLA
State : FL
Zip : 32501-1734
Country : US
Telephone Number : 850-455-1252
Fax Number : 844-683-8754
Authorized Official
Title or Position : CEO
Name : LADAYSHA L JACKSON
Credential : APRN
Telephone Number : 850-455-1252
Provider Enumeration Date : 12/24/2014
Last Update Date : 09/06/2023

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Directions to “JDPREMIUM HEALTHCARE, LLC ” Practice Location

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