Individual
MRS. JACKIE POLK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1201 1ST ST S, WINTER HAVEN, FL 33880-3904
(863) 297-1702
(863) 291-6755
Mailing address
1201 1ST ST S, WINTER HAVEN, FL 33880-3904
(863) 297-1702
(863) 291-6755
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN340111
FL
Other
Enumeration date
09/09/2008
Last updated
09/09/2008
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