Healthcare Provider Details

I. General information

NPI: 1548391600
Provider Name (Legal Business Name): JENNIFER KWARCIANY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W GORE ST STE 300
ORLANDO FL
32806-1052
US

IV. Provider business mailing address

1076 KENSINGTON PARK DR UNIT 205
ALTAMONTE SPRINGS FL
32714-5008
US

V. Phone/Fax

Practice location:
  • Phone: 407-254-2558
  • Fax:
Mailing address:
  • Phone: 407-257-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL1897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: