Individual
JOVAN MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
53745
NM
363LF0000X
Family Nurse Practitioner
APN.0992154-NP
CO
Other
Enumeration date
01/19/2016
Last updated
06/08/2023
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