1619939840 NPI number — MS. JANE C. CULLEN ARNP

Table of content: MS. JANE C. CULLEN ARNP (NPI 1619939840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619939840 NPI number — MS. JANE C. CULLEN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULLEN
Provider First Name:
JANE
Provider Middle Name:
C.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CULLEN
Provider Other First Name:
JANE
Provider Other Middle Name:
CRISWELL
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1619939840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7928 SW 17TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32607-3444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-331-8125
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SHCC UNIVERSITY OF FLORIDA CAMPUS
Provider Second Line Business Practice Location Address:
1 FLETCHER DRIVE
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32611-7500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-392-1161
Provider Business Practice Location Address Fax Number:
352-392-9625
Provider Enumeration Date:
04/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  ARNP 578432 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)