1982983086 NPI number — JANNEKE NICHELLE MCELROY

Table of content: DANIELLE BORDO PT, DPT (NPI 1174024343)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982983086 NPI number — JANNEKE NICHELLE MCELROY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCELROY
Provider First Name:
JANNEKE
Provider Middle Name:
NICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982983086
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12425 RACE TRACK RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33626-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-659-1522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 OLD MIDDLEBURG RD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32210-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-693-7620
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2011

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: 235Z00000X , 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)