Basic Information
| Provider Information | |||||||||
| NPI: | 1538188115 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWEET | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4932 W STATE ROAD 46 STE 1090 | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327719244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076353340 | ||||||||
| FaxNumber: | 4076367852 | ||||||||
| Practice Location | |||||||||
| Address1: | 4932 W STATE ROAD 46 STE 1090 | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32771 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076353340 | ||||||||
| FaxNumber: | 4076367852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 07/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME64008 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 372984200 | 05 | FL | MEDICAID | 18952 | 01 | FL | BCBS | OTHER | P00387706 | 01 | RAILROAD MEDICARE | OTHER |