Basic Information
| Provider Information | |||||||||
| NPI: | 1811364391 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | JONES | ||||||||
| FirstName: | ERIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2905 N MAIN ST | ||||||||
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| City: | DECATUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 625264274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178779117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7551 FOREST OAKS BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346062437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178779117 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2015 | ||||||||
| LastUpdateDate: | 11/28/2017 | ||||||||
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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 | 209.013083 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 021075800 | 05 | FL | MEDICAID |