Provider Demographics
NPI:1942700208
Name:DOE, JANE
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:DOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 MITCHELL RANCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3233
Mailing Address - Country:US
Mailing Address - Phone:727-271-8884
Mailing Address - Fax:727-848-5494
Practice Address - Street 1:10225 ULMERTON RD STE 10C
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3526
Practice Address - Country:US
Practice Address - Phone:727-261-6222
Practice Address - Fax:727-848-5494
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001819400253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001819400Medicaid