Provider Demographics
NPI:1265977300
Name:SCOTT, JEFFREY WAYNE (ARNP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WAYNE
Last Name:SCOTT
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1001 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-5025
Mailing Address - Country:US
Mailing Address - Phone:386-775-8718
Mailing Address - Fax:
Practice Address - Street 1:1001 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-5025
Practice Address - Country:US
Practice Address - Phone:386-775-8718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9302184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily