Provider Demographics
NPI:1407059298
Name:RANKIN, JERRY LEE (AP)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LEE
Last Name:RANKIN
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9207 SE 119TH PL
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-1602
Mailing Address - Country:US
Mailing Address - Phone:352-233-0751
Mailing Address - Fax:
Practice Address - Street 1:10250 SE 167TH PLACE RD
Practice Address - Street 2:SUITE 5-2
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8682
Practice Address - Country:US
Practice Address - Phone:352-233-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2223171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist