Individual
JACOB THOMAS BUKAWESKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP-BC
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610
(352) 273-5667
Mailing address
PO BOX 100108, GAINESVILLE, FL 32610-0108
(352) 273-5667
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
ARNP9385496
FL
363LA2100X
Acute Care Nurse Practitioner
RN9385496
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024811100
—
FL
Enumeration date
03/03/2018
Last updated
05/21/2018
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