Provider Demographics
NPI:1639271190
Name:LLOYD, JACQUELINE JORDAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JORDAN
Last Name:LLOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 W CALL ST
Mailing Address - Street 2:SUITE 3140-F
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-4300
Mailing Address - Country:US
Mailing Address - Phone:850-644-9423
Mailing Address - Fax:850-645-2824
Practice Address - Street 1:1115 W CALL ST
Practice Address - Street 2:SUITE 3140-F
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-4300
Practice Address - Country:US
Practice Address - Phone:850-644-9423
Practice Address - Fax:850-645-2824
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15824207QG0300X
FLME89320207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A97410Medicare UPIN