Healthcare Provider Details

I. General information

NPI: 1750764387
Provider Name (Legal Business Name): JENNIFER LYNN HOWELL RT (R)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN CARLISLE

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PARKWAY #450
BOCA RATON FL
33487-2787
US

IV. Provider business mailing address

5901 BROKEN SOUND PARKWAY #450
BOCA RATON FL
33487-2787
US

V. Phone/Fax

Practice location:
  • Phone: 888-367-2616
  • Fax: 844-263-6823
Mailing address:
  • Phone: 888-367-2616
  • Fax: 844-263-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number362625
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: