MEDICARE: ADRIANA JEPSEN MD

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	208000000X	Pediatrics Physician	MD056644L	PA
2	2080N0001X	Neonatal-Perinatal Medicine Physician	MD056644L	PA
3	2080N0001X	Neonatal-Perinatal Medicine Physician	ME157577	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1790773604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIANA JEPSEN MD

Provider Business Mailing Address
First Line	:	11190 HEALTH PARK BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-5729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11190 HEALTH PARK BLVD
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-5729
Country	:	US
Telephone Number	:	239-624-6120
Fax Number	:

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	10/30/2023

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