Individual
DR. JACQUELINE KORMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
220 BARTON BLVD UNIT C14, ROCKLEDGE, FL 32955-2742
(321) 433-8350
(321) 433-8351
Mailing address
PO BOX 1137, MELBOURNE, FL 32902-1137
(321) 952-9696
(321) 952-7937
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
HAD 16
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002042300
—
FL
01
—
59-2420282
TAX ID
—
Enumeration date
02/13/2006
Last updated
07/21/2022
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