Provider Demographics
NPI:1154586139
Name:FLETCHER, JERROD RYAN (AP)
Entity type:Individual
Prefix:MR
First Name:JERROD
Middle Name:RYAN
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
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Mailing Address - Street 1:9928 NW 226TH ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-7843
Mailing Address - Country:US
Mailing Address - Phone:352-281-8989
Mailing Address - Fax:352-371-2867
Practice Address - Street 1:4509 NW 23RD AVE
Practice Address - Street 2:SUITE 19-B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6570
Practice Address - Country:US
Practice Address - Phone:352-281-8989
Practice Address - Fax:352-371-2867
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2555171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist