Provider Demographics
NPI:1316320138
Name:CLINE, JANE SORRELLS
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:SORRELLS
Last Name:CLINE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:3600 S HIGHLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5416
Mailing Address - Country:US
Mailing Address - Phone:863-385-6101
Mailing Address - Fax:863-385-7379
Practice Address - Street 1:3600 S HIGHLANDS AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5416
Practice Address - Country:US
Practice Address - Phone:863-385-6101
Practice Address - Fax:863-385-7379
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18565183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59-2546390Medicare PIN