Provider Demographics
NPI:1780006940
Name:AMARO GARCIA, JEANINE
Entity Type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:AMARO GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8344 LOWER PERSE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7435
Mailing Address - Country:US
Mailing Address - Phone:402-208-4099
Mailing Address - Fax:
Practice Address - Street 1:14226 COLONIAL GRAND BLVD APT 2703
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4860
Practice Address - Country:US
Practice Address - Phone:402-208-4099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLMH13743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021766500Medicaid