Basic Information
| Provider Information | |||||||||
| NPI: | 1730566803 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEGAL | ||||||||
| FirstName: | JOCELYN | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15320 AMBERLY DR | ||||||||
| Address2: | SUITE B | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336471647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139770733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11924 SHELDON RD | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336263643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139262177 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2015 | ||||||||
| LastUpdateDate: | 11/28/2018 | ||||||||
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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 | 363LF0000X | ARNP1991712 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.