Healthcare Provider Details

I. General information

NPI: 1366366890
Provider Name (Legal Business Name): LEGAVIE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12211 REGENCY VILLAGE DR STE 9
ORLANDO FL
32821-7813
US

IV. Provider business mailing address

12211 REGENCY VILLAGE DR STE 9
ORLANDO FL
32821-7813
US

V. Phone/Fax

Practice location:
  • Phone: 904-698-9530
  • Fax:
Mailing address:
  • Phone: 904-698-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEIDI JIMENEZ
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 904-698-9530