Provider Demographics
NPI:1255688321
Name:JANKE, ED
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:JANKE
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 1:131 SW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-1434
Mailing Address - Country:US
Mailing Address - Phone:352-317-5101
Mailing Address - Fax:
Practice Address - Street 1:3500 NW 97TH BLVD STE N
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7342
Practice Address - Country:US
Practice Address - Phone:352-333-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications