Provider Demographics
NPI:1558775452
Name:MCCARTNEY, JARRET
Entity Type:Individual
Prefix:
First Name:JARRET
Middle Name:
Last Name:MCCARTNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 FIRETHORN PT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-9511
Mailing Address - Country:US
Mailing Address - Phone:352-593-7148
Mailing Address - Fax:352-688-7224
Practice Address - Street 1:11375 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5409
Practice Address - Country:US
Practice Address - Phone:352-593-7148
Practice Address - Fax:352-688-7224
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA206367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant