Healthcare Provider Details

I. General information

NPI: 1275647786
Provider Name (Legal Business Name): JANINA ELISBETH VANOVER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5329 NE 60TH AVE
HIGH SPRINGS FL
32643-5847
US

IV. Provider business mailing address

5329 NE 60TH AVE
HIGH SPRINGS FL
32643-5847
US

V. Phone/Fax

Practice location:
  • Phone: 386-454-8032
  • Fax:
Mailing address:
  • Phone: 386-454-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA25598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: