Healthcare Provider Details

I. General information

NPI: 1982112975
Provider Name (Legal Business Name): JOHNNY HADNOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST
ORLANDO FL
32803
US

IV. Provider business mailing address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

V. Phone/Fax

Practice location:
  • Phone: 407-646-5500
  • Fax:
Mailing address:
  • Phone: 407-646-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: