Healthcare Provider Details

I. General information

NPI: 1457138323
Provider Name (Legal Business Name): LENER JEUNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 TROPIC PARK DR
SANFORD FL
32773-6323
US

IV. Provider business mailing address

5913 IONA AVE
ORLANDO FL
32835-2029
US

V. Phone/Fax

Practice location:
  • Phone: 407-732-4605
  • Fax:
Mailing address:
  • Phone: 407-437-9127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: