MEDICARE: JUSTIN LENTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336849652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN LENTZ

Provider Business Mailing Address
First Line	:	2424 METFIELD DR APT 2404
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32940-5309
Country	:	US
Telephone Number	:	540-847-9592
Fax Number	:

Provider Business Practice Location Address
First Line	:	2335 S WASHINGTON AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-4737
Country	:	US
Telephone Number	:	321-593-0458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	03/06/2023

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Directions to “ JUSTIN LENTZ ” Practice Location

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