Healthcare Provider Details

I. General information

NPI: 1164695888
Provider Name (Legal Business Name): JENSEN BEACH ANIMAL HOSPITAL , LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 NE ARCH AVE
JENSEN BEACH FL
34957-5755
US

IV. Provider business mailing address

1553 NE ARCH AVE
JENSEN BEACH FL
34957-5755
US

V. Phone/Fax

Practice location:
  • Phone: 772-334-5010
  • Fax: 772-334-7447
Mailing address:
  • Phone: 772-334-5010
  • Fax: 772-334-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberVE3623
License Number StateFL

VIII. Authorized Official

Name: MR. BRIAN KREITZ
Title or Position: OWNER
Credential: DVM
Phone: 772-334-5010