MEDICARE: JANNEKE NICHELLE MCELROY

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	235Z00000X	Speech-Language Pathologist		FL

General Provider Information

NPI Number	:	1982983086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANNEKE NICHELLE MCELROY

Provider Business Mailing Address
First Line	:	12425 RACE TRACK RD
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33626-3110
Country	:	US
Telephone Number	:	800-659-1522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 OLD MIDDLEBURG RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-1232
Country	:	US
Telephone Number	:	904-693-7620
Fax Number	:

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

Provider Enumeration Date	:	08/08/2011
Last Update Date	:	08/08/2011

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Directions to “ JANNEKE NICHELLE MCELROY ” Practice Location

Language	Start Address	Practice Location

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