Provider Demographics
NPI:1790481778
Name:LAYNE, JEFFREY (SPOUSE)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:LAYNE
Suffix:
Gender:M
Credentials:SPOUSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2502
Mailing Address - Country:US
Mailing Address - Phone:850-347-4738
Mailing Address - Fax:
Practice Address - Street 1:2605 W 16TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2502
Practice Address - Country:US
Practice Address - Phone:850-347-4738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care