Healthcare Provider Details

I. General information

NPI: 1578055620
Provider Name (Legal Business Name): J MICHEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5645 PINEY RIDGE DR
ORLANDO FL
32808-4874
US

IV. Provider business mailing address

PO BOX 681813
ORLANDO FL
32868-1813
US

V. Phone/Fax

Practice location:
  • Phone: 407-580-5036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number234799
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number234799
License Number StateFL

VIII. Authorized Official

Name: JUDITH MICHEL-JACKSON
Title or Position: OWNER/OPERATOR
Credential:
Phone: 407-267-1525