MEDICARE: JUAWANA MONTGOMERY

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	171M00000X	Case Manager/Care Coordinator
2	175T00000X	Peer Specialist		FL

General Provider Information

NPI Number	:	1386507853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAWANA MONTGOMERY

Provider Business Mailing Address
First Line	:	5768 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5768 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-4818
Country	:	US
Telephone Number	:	407-896-2323
Fax Number	:

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

Provider Enumeration Date	:	12/03/2025
Last Update Date	:	01/06/2026

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Directions to “ JUAWANA MONTGOMERY ” Practice Location

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