Provider Demographics
NPI:1639805823
Name:J.A.G REDEFINED HEALTHCARE
Entity Type:Organization
Organization Name:J.A.G REDEFINED HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:239-913-7242
Mailing Address - Street 1:840 111TH AVE N STE 10
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-1868
Mailing Address - Country:US
Mailing Address - Phone:239-913-7242
Mailing Address - Fax:239-443-4747
Practice Address - Street 1:840 111TH AVE N STE 10
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-1868
Practice Address - Country:US
Practice Address - Phone:239-913-7242
Practice Address - Fax:239-443-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty