Provider Demographics
NPI:1558009365
Name:NOVA TELECLINIC LLC
Entity Type:Organization
Organization Name:NOVA TELECLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAIMES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:407-602-8551
Mailing Address - Street 1:365 WEKIVA SPRINGS RD STE 231
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3690
Mailing Address - Country:US
Mailing Address - Phone:321-413-1411
Mailing Address - Fax:321-379-6923
Practice Address - Street 1:365 WEKIVA SPRINGS RD STE 231
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3690
Practice Address - Country:US
Practice Address - Phone:321-413-1411
Practice Address - Fax:321-379-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty