Organization
BLUEROCK MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIE LECLAIR SPENCER DNP, APRN, FNP-C (OWNER)
(863) 873-0072
Entity
Organization
Contact information
Practice address
810 N RIDGEWOOD DR, SEBRING, FL 33870-7217
(863) 873-0072
Mailing address
505 SUMMIT DR, SEBRING, FL 33870-2341
(863) 873-0072
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1164189015
NPI
FL
Enumeration date
02/07/2024
Last updated
03/04/2024
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