Healthcare Provider Details

I. General information

NPI: 1649189127
Provider Name (Legal Business Name): JADEN PAYGE LENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047B JOHN SIMS PKWY E
NICEVILLE FL
32578-2712
US

IV. Provider business mailing address

1047B JOHN SIMS PKWY E
NICEVILLE FL
32578-2712
US

V. Phone/Fax

Practice location:
  • Phone: 850-729-1086
  • Fax:
Mailing address:
  • Phone: 850-729-1086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA35034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: