Individual
JOYCE A JACKOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
714 DOCTORS DR, ENGLEWOOD, FL 34223-3992
(941) 460-1300
(941) 460-1306
Mailing address
4371 VERONICA S SHOEMAKER BLVD, ATTN CREDENTIALING, FORT MYERS, FL 33916-2216
(239) 274-7820
(239) 278-3350
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024168707
VA
363L00000X
Nurse Practitioner
Primary
ARNP9396947
FL
363L00000X
Nurse Practitioner
NP07980
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000391441
ANTHEM
—
05
—
2519984
—
OH
Enumeration date
06/06/2006
Last updated
07/27/2015
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