MEDICARE: JANET LYNN DAUGHTRY ARNP-CNM

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	ARNP2512222	FL
2	367A00000X	Advanced Practice Midwife	ARNP2512222	FL

General Provider Information

NPI Number	:	1568573830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET LYNN DAUGHTRY ARNP-CNM

Provider Business Mailing Address
First Line	:	3268 66TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1511
Country	:	US
Telephone Number	:	727-456-0750
Fax Number	:	727-456-0751

Provider Business Practice Location Address
First Line	:	3268 66TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33710-1511
Country	:	US
Telephone Number	:	727-456-0750
Fax Number	:	727-456-0751

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/24/2019

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