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General NPI Number Information
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NPI Number | 1316616022
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Entity Type | Organization
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Legal Business Name | MEDITELE LLC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 216 JACKSON LOOP
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City | DELAND
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State | FL
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Zip | 32724-3251
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Country | US
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Telephone | 646-346-4709
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Fax |
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Provider Business Mailing Address
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Address Line | 216 JACKSON LOOP
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City | DELAND
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State | FL
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Zip | 32724-3251
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Country | US
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Telephone | 646-346-4709
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | JANET A HERON
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Credential | ARNP
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Telephone | 646-346-4709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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