Provider Demographics
NPI:1659507671
Name:JIANNETTO INSTITUTE LLC
Entity Type:Organization
Organization Name:JIANNETTO INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:JIANNETTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-907-7031
Mailing Address - Street 1:27406 CASHFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8199
Mailing Address - Country:US
Mailing Address - Phone:813-907-7031
Mailing Address - Fax:813-907-7083
Practice Address - Street 1:27406 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8199
Practice Address - Country:US
Practice Address - Phone:813-907-7031
Practice Address - Fax:813-907-7083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81509207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G27456Medicare UPIN
78744Medicare PIN