Provider Demographics
NPI:1457336034
Name:FRANCOEUR, JERI (MS ATC)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:
Last Name:FRANCOEUR
Suffix:
Gender:F
Credentials:MS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1508
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32175-1508
Mailing Address - Country:US
Mailing Address - Phone:386-615-4990
Mailing Address - Fax:386-615-4951
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-615-4990
Practice Address - Fax:386-615-4951
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
FLAL562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1182500001Medicare NSC