Healthcare Provider Details

I. General information

NPI: 1275206625
Provider Name (Legal Business Name): JPL FOOT AND ANKLE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 3RD ST SW # 105
WINTER HAVEN FL
33880-3913
US

IV. Provider business mailing address

1300 3RD ST SW # 105
WINTER HAVEN FL
33880-3913
US

V. Phone/Fax

Practice location:
  • Phone: 917-482-1347
  • Fax: 866-864-8671
Mailing address:
  • Phone:
  • Fax: 866-864-8671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: JESSY PIERRE-LOUIS
Title or Position: OWNER
Credential: DPM
Phone: 917-482-1347