MEDICARE: JACQUELINE ISABEL ATKIN 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	363LF0000X	Family Nurse Practitioner	9326640	FL

General Provider Information

NPI Number	:	1750897179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE ISABEL ATKIN ARNP

Provider Business Mailing Address
First Line	:	2000 S ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-3430
Country	:	US
Telephone Number	:	954-653-2196
Fax Number	:	954-653-2499

Provider Business Practice Location Address
First Line	:	2000 S ANDREWS AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-3430
Country	:	US
Telephone Number	:	954-653-2196
Fax Number	:	954-653-2499

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	12/18/2018

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