Healthcare Provider Details

I. General information

NPI: 1679101273
Provider Name (Legal Business Name): PAUL HENRY JANKOWSKI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 SLIGH BLVD
ORLANDO FL
32806-3954
US

IV. Provider business mailing address

2544 MAYER ST
ORLANDO FL
32806-4811
US

V. Phone/Fax

Practice location:
  • Phone: 305-899-3379
  • Fax:
Mailing address:
  • Phone: 321-652-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9531292
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number11019911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: