MEDICARE: MARTHA NAN JOBSON LCSW

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	1041C0700X	Clinical Social Worker	SW1438	FL

General Provider Information

NPI Number	:	1780642959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA NAN JOBSON LCSW

Provider Business Mailing Address
First Line	:	9951 ATLANTIC BLVD
Second Line	:	BLDG 4, SUITE 418
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6584
Country	:	US
Telephone Number	:	904-493-2105
Fax Number	:	904-493-2104

Provider Business Practice Location Address
First Line	:	9951 ATLANTIC BLVD
Second Line	:	BLDG 4, SUITE 418
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6584
Country	:	US
Telephone Number	:	904-493-2105
Fax Number	:	904-493-2104

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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