Basic Information
| Provider Information | |||||||||
| NPI: | 1912935156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOUSTON | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | |||||||||
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| Credential: | APRN/CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 NW 43RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326076110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523327222 | ||||||||
| FaxNumber: | 3523327330 | ||||||||
| Practice Location | |||||||||
| Address1: | 724 NW 43RD STREET | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326073260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523327222 | ||||||||
| FaxNumber: | 3523327330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | ARNP 3110692 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LX0001X | APRN3110692 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 003175218A | 05 | GA | MEDICAID | 075450100 | 05 | FL | MEDICAID |