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Provider Information for 1669582821

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

MRS. JAN DENICE PHELPS ARNP

Gender: FEMALE

Individual NPI: 1669582821

Calendar   Last Updated:  2021-07-27
  Certification Date:  2021-07-27

Details

Name Value
NPI 1669582821
Enumeration Date 2006-08-30
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 2553 MASON OAKS DR
VALRICO, FL 33596-6498
United States

Phone: 813-940-6046 | Fax: 866-451-4607
View Map External Link
Primary Practice Address 2553 MASON OAKS DR
VALRICO, FL 33596-6498
United States

Phone: 813-940-6046 | Fax: 866-451-4607
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other LICENSE NUMBER FL 1851392
Other NPI FL 1669582821
MEDICAID FL 305568000
Other NPI BUSINESS FL 1326237850
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family FL 1851392