Provider Demographics
NPI:1750097267
Name:KING, JODY MICHELE (ARNP, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:MICHELE
Last Name:KING
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 S YONGE ST
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-6257
Mailing Address - Country:US
Mailing Address - Phone:386-673-2133
Mailing Address - Fax:386-673-2743
Practice Address - Street 1:279 S YONGE ST
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6257
Practice Address - Country:US
Practice Address - Phone:386-673-2133
Practice Address - Fax:386-673-2743
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023456207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine