=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518266931
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K & J ASSISTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2011
-----------------------------------------------------
Last Update Date | 02/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 122 ANNIE ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-843-2811
-----------------------------------------------------
Fax | 407-545-4343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 122 ANNIE ST
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32806-1214
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-843-2811
-----------------------------------------------------
Fax | 407-545-4343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CERTIFIED SURGICAL FIRST ASSISTANT
-----------------------------------------------------
Name | JOLEEN CHAPMAN
-----------------------------------------------------
Credential | CSFA
-----------------------------------------------------
Telephone | 407-616-7490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------