Provider Demographics
NPI:1114788288
Name:JASPER HEALTH SERVICES FLORIDA LLC
Entity Type:Organization
Organization Name:JASPER HEALTH SERVICES FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL & COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-312-6332
Mailing Address - Street 1:950 W BANNOCK ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6140
Mailing Address - Country:US
Mailing Address - Phone:302-312-6332
Mailing Address - Fax:
Practice Address - Street 1:4210 VALLEY RIDGE BLVD STE 135
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5183
Practice Address - Country:US
Practice Address - Phone:929-552-3904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty