MEDICARE: APRN MEDICAL SERVICES, 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
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1568933216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APRN MEDICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	5331 CORDGRASS BEND LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-3000
Country	:	US
Telephone Number	:	386-506-2992
Fax Number	:

Provider Business Practice Location Address
First Line	:	5331 CORDGRASS BEND LN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-3000
Country	:	US
Telephone Number	:	386-506-2992
Fax Number	:

Authorized Official
Title or Position	:	FAMILY NURSE PRACTITIONER
Name	:	MS. JESSICA KAILEE WHITE
Credential	:	APRN-BC
Telephone Number	:	386-506-2992

Provider Enumeration Date	:	12/06/2018
Last Update Date	:	12/06/2018

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