Provider Demographics
NPI:1487674529
Name:WHITE, JACKIE C (CNM)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2801 SE 1ST AVE
Mailing Address - Street 2:101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0409
Mailing Address - Country:US
Mailing Address - Phone:352-690-6300
Mailing Address - Fax:352-690-6802
Practice Address - Street 1:2801 SE 1ST AVE
Practice Address - Street 2:101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0409
Practice Address - Country:US
Practice Address - Phone:352-690-6300
Practice Address - Fax:352-690-6802
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9189802367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305220600Medicaid
FL305220600Medicaid