Provider Demographics
NPI:1013206432
Name:HALFERTY, JERRI LYNN (LMT;NMT)
Entity Type:Individual
Prefix:MRS
First Name:JERRI
Middle Name:LYNN
Last Name:HALFERTY
Suffix:
Gender:F
Credentials:LMT;NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 ROBINHOOD ST STE C
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3620
Mailing Address - Country:US
Mailing Address - Phone:941-302-1758
Mailing Address - Fax:941-365-5918
Practice Address - Street 1:1910 ROBINHOOD ST STE C
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3620
Practice Address - Country:US
Practice Address - Phone:941-302-1758
Practice Address - Fax:941-365-5918
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45639171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor