Healthcare Provider Details

I. General information

NPI: 1235680026
Provider Name (Legal Business Name): JODI LYNN HALBLEIB RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 KUHL AVE
ORLANDO FL
32806-2008
US

IV. Provider business mailing address

5029 SWEET LEAF CT
ALTAMONTE SPRINGS FL
32714-1266
US

V. Phone/Fax

Practice location:
  • Phone: 407-461-3050
  • Fax:
Mailing address:
  • Phone: 407-461-3050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9312341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: