Healthcare Provider Details

I. General information

NPI: 1154200350
Provider Name (Legal Business Name): JIHO JU APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 TAMPA RD
OLDSMAR FL
34677-3114
US

IV. Provider business mailing address

3919 TAMPA RD
OLDSMAR FL
34677-3114
US

V. Phone/Fax

Practice location:
  • Phone: 571-512-2625
  • Fax:
Mailing address:
  • Phone: 571-512-2625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11049519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: