National Provider Identifier Database

5JAGHEALTH PLLC
Family


Contact Information

5JAGHEALTH, PLLC
112 IRVIN AVE SW
LIVE OAK, FL32064-2214
Phone: 386-647-6144
Fax:
Website:
Specialty Taxonomy Code
* Family 363LF0000X
Family Medicine 207Q00000X

* Indicates primary specialty

NPI Profile & details for 5JAGHEALTH, PLLC

NPI Number 1407636582
Legal business name
LBN
5JAGHEALTH, PLLC
Authorized official AYMEE WILSON - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 10/04/2023
Last updated 02/08/2024 - About 2 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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