MEDICARE: HECTOR JAIME 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	11004780	FL

General Provider Information

NPI Number	:	1902449606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR JAIME FNP-C

Provider Business Mailing Address
First Line	:	1304 WINTER SPRINGS BLVD
Second Line	:
City	:	WINTER SPGS
State	:	FL
Zip	:	32708-3801
Country	:	US
Telephone Number	:	321-439-7775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1304 WINTER SPRINGS BLVD
Second Line	:
City	:	WINTER SPGS
State	:	FL
Zip	:	32708-3801
Country	:	US
Telephone Number	:	321-439-7775
Fax Number	:

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

Provider Enumeration Date	:	10/25/2019
Last Update Date	:	10/25/2019

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