Provider Demographics
NPI:1720614860
Name:CUBERO, JANNELLE DANA
Entity Type:Individual
Prefix:
First Name:JANNELLE
Middle Name:DANA
Last Name:CUBERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27138 FERN GLADE CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8191
Mailing Address - Country:US
Mailing Address - Phone:813-774-0701
Mailing Address - Fax:
Practice Address - Street 1:27138 FERN GLADE CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8191
Practice Address - Country:US
Practice Address - Phone:813-774-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28319225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant