=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760394076
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY RENEE JANOWICZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2026
-----------------------------------------------------
Last Update Date | 09/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3190 SUNTREE BLVD STE 101
-----------------------------------------------------
City | ROCKLEDGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32955-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-623-4369
-----------------------------------------------------
Fax | 321-306-2787
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3190 SUNTREE BLVD STE 101
-----------------------------------------------------
City | ROCKLEDGE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32955-5741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-623-4369
-----------------------------------------------------
Fax | 321-306-2787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------