Provider Demographics
NPI:1407636582
Name:5JAGHEALTH, PLLC
Entity Type:Organization
Organization Name:5JAGHEALTH, PLLC
Other - Org Name:SUWANNEE OAKS MEDICAL PRIMARY AND WELLNESS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AYMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-330-6380
Mailing Address - Street 1:8405 127TH DR
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-8835
Mailing Address - Country:US
Mailing Address - Phone:386-647-6144
Mailing Address - Fax:
Practice Address - Street 1:112 IRVIN AVE SW
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-2214
Practice Address - Country:US
Practice Address - Phone:386-647-6144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-04
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty