Healthcare Provider Details

I. General information

NPI: 1114394962
Provider Name (Legal Business Name): JAMAINE HARVIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7737 PENGROVE PASS
ORLANDO FL
32835-6814
US

IV. Provider business mailing address

7737 PENGROVE PASS
ORLANDO FL
32835-6814
US

V. Phone/Fax

Practice location:
  • Phone: 407-432-6914
  • Fax:
Mailing address:
  • Phone: 407-432-6914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberH615-433-74-045-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: