Provider Demographics
NPI:1174280036
Name:NEGRON, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:NEGRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 LEGACY CT APT 14-103
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-1060
Mailing Address - Country:US
Mailing Address - Phone:407-257-7396
Mailing Address - Fax:
Practice Address - Street 1:8905 LEGACY CT APT 14-103
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-1060
Practice Address - Country:US
Practice Address - Phone:407-257-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN265420618080OtherDRIVER LICENSE