Provider Demographics
NPI:1023274537
Name:DIFRANCO, JEANNINE A (ATC, CSCS)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:A
Last Name:DIFRANCO
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WOLF PACK RUN
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2923
Mailing Address - Country:US
Mailing Address - Phone:386-785-3565
Mailing Address - Fax:
Practice Address - Street 1:100 WOLF PACK RUN
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-2923
Practice Address - Country:US
Practice Address - Phone:386-785-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL #24312255A2300X
OHAT-8082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer