Healthcare Provider Details

I. General information

NPI: 1417893454
Provider Name (Legal Business Name): CHANDRA JONETTA KOON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 26TH ST
ORLANDO FL
32805-5433
US

IV. Provider business mailing address

1016 26TH ST
ORLANDO FL
32805-5433
US

V. Phone/Fax

Practice location:
  • Phone: 407-721-8788
  • Fax:
Mailing address:
  • Phone: 407-721-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9288724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: