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Individual

JONATHAN MAXWELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DNP

Contact information

Practice address
5619 NW 202ND PL, LA CROSSE, FL 32658
(386) 418-0545
Mailing address
PO BOX 312, LA CROSSE, FL 32658-0312
(386) 418-0545

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN11029322
FL

Other

Enumeration date
01/16/2024
Last updated
01/16/2024
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