Provider Demographics
NPI:1114394962
Name:HARVIN, JAMAINE
Entity Type:Individual
Prefix:
First Name:JAMAINE
Middle Name:
Last Name:HARVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7737 PENGROVE PASS
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6814
Mailing Address - Country:US
Mailing Address - Phone:407-432-6914
Mailing Address - Fax:
Practice Address - Street 1:7737 PENGROVE PASS
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6814
Practice Address - Country:US
Practice Address - Phone:407-432-6914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH615-433-74-045-0172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver