Provider Demographics
NPI:1336338417
Name:JAIRO R NUNEZ MD PA
Entity Type:Organization
Organization Name:JAIRO R NUNEZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-671-2258
Mailing Address - Street 1:1485 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 1454, BLDG. 6
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5533
Mailing Address - Country:US
Mailing Address - Phone:407-671-2258
Mailing Address - Fax:407-671-2675
Practice Address - Street 1:1485 S SEMORAN BLVD
Practice Address - Street 2:SUITE 1454, BLDG. 6
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5533
Practice Address - Country:US
Practice Address - Phone:407-671-2258
Practice Address - Fax:407-671-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00655982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26994Medicare PIN
FLC33191Medicare UPIN