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General NPI Number Information
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NPI Number | 1811000516
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Entity Type | Individual
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Provider Name | JENETTE LYNN CANTRELL OD
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 10000 BAY PINES BLVD
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City | BAY PINES
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State | FL
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Zip | 33744
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Country | US
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Telephone | 727-398-6661
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Fax |
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Provider Business Mailing Address
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Address Line | VAMC BAY PINES PO BOX 5005 3A-EYE CLINIC
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City | BAY PINES
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State | FL
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Zip | 33744
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Country | US
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Telephone | 727-398-6661
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC 3783
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License Number State | FL
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