Basic Information
| Provider Information | |||||||||
| NPI: | 1164411641 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECKERT | ||||||||
| FirstName: | JEANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2114 AIRPORT BLVD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504763696 | ||||||||
| FaxNumber: | 8504773573 | ||||||||
| Practice Location | |||||||||
| Address1: | 2114 AIRPORT BLVD | ||||||||
| Address2: | SUITE 1000 | ||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325048926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504763696 | ||||||||
| FaxNumber: | 8504773573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME71316 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 31621Y | 01 | FL | FLORIDA MEDICARE | OTHER | P00101747 | 01 | FL | MEDICARE RR | OTHER | 4498680 | 01 | FL | AETNA | OTHER | 59082971 | 01 | FL | BCBS AL | OTHER | 0706940 | 01 | FL | UNITED HEALTHCARE | OTHER | 250566500 | 05 | FL | MEDICAID | 31621 | 01 | FL | BCBSFL | OTHER | Z257 | 01 | FL | HEALTH FIRST NETWORK | OTHER | 5116502003 | 01 | FL | CIGNA | OTHER |