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NPI Code Detail

MEDICARE: DR. AUDREY ELAINE JAIN D.O.

MEDICARE: DR. AUDREY ELAINE JAIN D.O.
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
12084P0800XPsychiatry PhysicianOS12524FL
22084P0800XPsychiatry Physician82259GA
32084P0800XPsychiatry PhysicianE-11899AR
42084P0800XPsychiatry Physician25MB10492700NJ
52084P0800XPsychiatry Physician3633TN
62084P0800XPsychiatry PhysicianDO034800DC
72084P0800XPsychiatry PhysicianC20012975DE

General Provider Information

NPI Number : 1841275864
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AUDREY ELAINE JAIN D.O.
Provider Business Mailing Address
First Line : PO BOX 95004
Second Line :
City : LAKELAND
State : FL
Zip : 33804-5004
Country : US
Telephone Number : 863-680-7000
Fax Number : 866-264-8519
Provider Business Practice Location Address
First Line : 1033 N PARKWAY FRONTAGE RD
Second Line :
City : LAKELAND
State : FL
Zip : 33803-0401
Country : US
Telephone Number : 863-647-8011
Fax Number : 863-647-8021
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 10/22/2019

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