Provider Demographics
NPI:1831364207
Name:ALVARO J JARQUIN MD PA
Entity type:Organization
Organization Name:ALVARO J JARQUIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCILLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-635-4100
Mailing Address - Street 1:205-A N SCENIC HWY
Mailing Address - Street 2:#300
Mailing Address - City:FROSTPROOF
Mailing Address - State:FL
Mailing Address - Zip Code:33843
Mailing Address - Country:US
Mailing Address - Phone:863-635-4100
Mailing Address - Fax:863-635-4499
Practice Address - Street 1:205 N SCENIC HWY #300
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843
Practice Address - Country:US
Practice Address - Phone:863-635-4100
Practice Address - Fax:863-635-4499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7511Medicare PIN
FL49461ZMedicare PIN
FLH06871Medicare UPIN