Healthcare Provider Details

I. General information

NPI: 1093458770
Provider Name (Legal Business Name): COLE STUART JAHNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 ORIENTA AVE STE 1011
ALTAMONTE SPRINGS FL
32701-5675
US

IV. Provider business mailing address

745 ORIENTA AVE STE 1011 745 ORIENTA AVE STE 1011
ALTAMONTE SPRINGS FL
32701-5675
US

V. Phone/Fax

Practice location:
  • Phone: 877-823-4283
  • Fax:
Mailing address:
  • Phone: 877-823-4283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90976
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: