NPI 1073882783

Jackies Retirement LLC

Organisation Exclusive Provider Organization Palm Bay, FL

Practice location

Address: 1675 Canon Ave NW, Palm Bay, FL 32907-8528
Phone: (321) 420-3916

Authorised official

Name: Jacqueline B Wright
Title: Administrator/Owner
Phone: (321) 420-3916

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence AL12053 (FL)

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Registry record

NPI: 1073882783
Entity type: Organization
NPI issued: 26 Dec 2011
Record last updated: 26 Dec 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.