Provider Demographics
NPI:1013261403
Name:CONN, JANELL ZZ PIPER (PTA)
Entity Type:Individual
Prefix:
First Name:JANELL
Middle Name:ZZ PIPER
Last Name:CONN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 SW 19TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-1748
Mailing Address - Country:US
Mailing Address - Phone:352-816-2474
Mailing Address - Fax:
Practice Address - Street 1:3930 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-5086
Practice Address - Country:US
Practice Address - Phone:352-236-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22544314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility