Healthcare Provider Details

I. General information

NPI: 1417827734
Provider Name (Legal Business Name): JANELLE JOHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 W LAUREL 100 #2084
SPRING HILL FL
34609-2773
US

IV. Provider business mailing address

5005 W LAUREL ST
TAMPA FL
33607-3886
US

V. Phone/Fax

Practice location:
  • Phone: 813-369-2561
  • Fax:
Mailing address:
  • Phone: 813-369-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: