Healthcare Provider Details

I. General information

NPI: 1447870696
Provider Name (Legal Business Name): TASHZNA DEENLEE JONES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 PORTER RD STE 201
WINTER GARDEN FL
34787-8800
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 407-298-6950
  • Fax: 321-843-6316
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME179219
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA201308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: