# FLORIDA DEPARTMENT OF VETERANS AFFAIRS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Douglas T. Jacobson State Veterans Nursing Home, Douglas Jacobson State Veterans Nursing Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629060272
- **Authorized official:** MR. WILLIAM G PUCKETT (PROGRAM DIRECTOR)
- **Authorized official phone:** (727) 518-3202

## Contact information

- **Practice address:** 21281 GRAYTON TER, PORT CHARLOTTE, FL 33954-3109
- **Practice address phone:** (941) 613-0919
- **Practice address fax:** (941) 613-0935
- **Mailing address:** 21281 GRAYTON TER, PORT CHARLOTTE, FL 33954-3109
- **Mailing address phone:** (941) 613-0919
- **Mailing address fax:** (941) 613-0935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | SNF130471029 | FL | Yes |
| 314000000X | Skilled Nursing Facility | SNF130471029 | FL | — |

## Other

- **Enumeration date:** 08/19/2005
- **Last updated:** 07/08/2026