Provider Demographics
NPI:1912935156
Name:HOUSTON, JANE (APRN/CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:APRN/CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 NW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6110
Mailing Address - Country:US
Mailing Address - Phone:352-332-7222
Mailing Address - Fax:352-332-7330
Practice Address - Street 1:724 NW 43RD STREET
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-3260
Practice Address - Country:US
Practice Address - Phone:352-332-7222
Practice Address - Fax:352-332-7330
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3110692367A00000X
FLAPRN3110692363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175218AMedicaid
FL075450100Medicaid
GA003175218AMedicaid