Healthcare Provider Details

I. General information

NPI: 1750623641
Provider Name (Legal Business Name): JNT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 W OAK RIDGE RD
ORLANDO FL
32809-3909
US

IV. Provider business mailing address

1745 W OAK RIDGE RD
ORLANDO FL
32809-3909
US

V. Phone/Fax

Practice location:
  • Phone: 407-203-6750
  • Fax: 407-203-6755
Mailing address:
  • Phone: 407-203-6750
  • Fax: 407-203-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26637
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNY NGUYEN
Title or Position: CEO
Credential:
Phone: 407-203-6750