Provider Demographics
NPI:1932348976
Name:PETCHAUER, JODI (WHNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:PETCHAUER
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8075 GATE PKWY W
Mailing Address - Street 2:SUITE 305
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3684
Mailing Address - Country:US
Mailing Address - Phone:904-296-2992
Mailing Address - Fax:904-296-2993
Practice Address - Street 1:8075 GATE PKWY W
Practice Address - Street 2:SUITE 305
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3684
Practice Address - Country:US
Practice Address - Phone:904-296-2992
Practice Address - Fax:904-296-2993
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3033212163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3033212Other3033212 FL