Healthcare Provider Details

I. General information

NPI: 1235821885
Provider Name (Legal Business Name): JACHIA LOUISGENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
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 TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: