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General NPI Number Information
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NPI Number | 1538969100
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Entity Type | Organization
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Legal Business Name | JONI'S BEAUTY BAR LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 10209 E COLONIAL DR STE 160
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City | ORLANDO
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State | FL
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Zip | 32817-4337
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Country | US
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Telephone | 407-413-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 10209 E COLONIAL DR STE 160
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City | ORLANDO
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State | FL
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Zip | 32817-4337
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Country | US
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Telephone | 407-413-5330
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHNNETTA LATRICE LYNUM CLEMONS
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Credential |
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Telephone | 407-897-0737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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