Provider Demographics
NPI:1700964798
Name:ROYCE, JACQUELINE FRANNIE (DO)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FRANNIE
Last Name:ROYCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 6TH AVE. W.
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8820
Mailing Address - Country:US
Mailing Address - Phone:941-358-3223
Mailing Address - Fax:941-358-8422
Practice Address - Street 1:357 6TH AVE. W.
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8820
Practice Address - Country:US
Practice Address - Phone:941-358-3223
Practice Address - Fax:941-358-8422
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8381208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01959OtherFL BCBS
FL1700964798OtherNPI
FLP00126504OtherRAILROAD MEDICARE
FL01959ZOtherPTAN
G86367Medicare UPIN