Healthcare Provider Details

I. General information

NPI: 1114788288
Provider Name (Legal Business Name): JASPER HEALTH SERVICES FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N WESTMONTE DR 1ST AND 2ND FLOOR
ALTAMONTE SPRINGS FL
32714-3345
US

IV. Provider business mailing address

235 N WESTMONTE DR 1ST AND 2ND FLOOR
ALTAMONTE SPRINGS FL
32714-3345
US

V. Phone/Fax

Practice location:
  • Phone: 929-552-3904
  • Fax: 877-254-0980
Mailing address:
  • Phone: 929-552-3904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GREG ORR
Title or Position: COO
Credential:
Phone: 702-419-5668