MEDICARE: JEAN M CERVINI-KOBY ARNP-FNP-C

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	1797912	FL

General Provider Information

NPI Number	:	1831604354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M CERVINI-KOBY ARNP-FNP-C

Provider Business Mailing Address
First Line	:	442 NAUTILUS DR
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-3931
Country	:	US
Telephone Number	:	321-591-5289
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 S COURTENAY PKWY
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32952-4886
Country	:	US
Telephone Number	:	321-453-3420
Fax Number	:

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

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	01/10/2020

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