MEDICARE: JNT HEALTHCARE LLC

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	3336S0011X	Specialty Pharmacy
2	3336C0004X	Compounding Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	333600000X	Pharmacy
5	3336C0003X	Community/Retail Pharmacy	PH26637	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5713866	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1750623641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JNT HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1745 W OAK RIDGE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-3909
Country	:	US
Telephone Number	:	407-203-6750
Fax Number	:	407-203-6755

Provider Business Practice Location Address
First Line	:	1745 W OAK RIDGE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-3909
Country	:	US
Telephone Number	:	407-203-6750
Fax Number	:	407-203-6755

Authorized Official
Title or Position	:	CEO
Name	:	JENNY NGUYEN
Credential	:
Telephone Number	:	407-203-6750

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	03/28/2013

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