NPI 1407636582 · live from the CMS NPI Registry
5jaghealth, PLLC
Nurse Practitioner, Family in Live Oak, FL. National Provider Identifier 1407636582, active.
NPI record
| NPI | 1407636582 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 112 Irvin Ave Sw, Live Oak, FL 32064 |
| Practice phone | 386-647-6144 |
| Mailing address | 8405 127th Dr, Live Oak, FL 32060 |
| Enumerated | October 4, 2023 |
| Last updated | February 8, 2024 |
| Authorized official | Aymee Wilson, Owner |
| Other names | Suwannee Oaks Medical Primary And Wellness Clinic |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Medicine | 207Q00000X | — |
| Nurse Practitioner, Family primary | 363LF0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.