Provider Demographics
NPI:1609653229
Name:TALAVERA, JELAINE JOSE
Entity Type:Individual
Prefix:MISS
First Name:JELAINE
Middle Name:JOSE
Last Name:TALAVERA
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 1:1908 BOOTHE CIR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6774
Mailing Address - Country:US
Mailing Address - Phone:407-573-7203
Mailing Address - Fax:855-437-3395
Practice Address - Street 1:1908 BOOTHE CIR
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-6774
Practice Address - Country:US
Practice Address - Phone:407-573-7206
Practice Address - Fax:855-437-3395
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171400000X171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach