Provider Demographics
NPI:1891785218
Name:NEGRON, JANNETTE H (MD)
Entity Type:Individual
Prefix:DR
First Name:JANNETTE
Middle Name:H
Last Name:NEGRON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANNETTE
Other - Middle Name:H
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3464 AVALON PARK EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7363
Mailing Address - Country:US
Mailing Address - Phone:407-635-3020
Mailing Address - Fax:321-203-4607
Practice Address - Street 1:3464 AVALON PARK EAST BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7363
Practice Address - Country:US
Practice Address - Phone:407-635-3020
Practice Address - Fax:321-203-4607
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79451208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258619300Medicaid
H20836Medicare UPIN