Provider Demographics
NPI:1144418666
Name:JARQUIN FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:JARQUIN FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:JARQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-635-4100
Mailing Address - Street 1:205 N SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:FROSTPROOF
Mailing Address - State:FL
Mailing Address - Zip Code:33843
Mailing Address - Country:US
Mailing Address - Phone:863-635-4100
Mailing Address - Fax:863-635-4499
Practice Address - Street 1:205 N SCENIC HWY
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843
Practice Address - Country:US
Practice Address - Phone:863-635-4100
Practice Address - Fax:863-635-4499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JARQUIN FAMILY PRACTICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty