Provider Demographics
NPI:1750088340
Name:KLUNK, JAMIE LEE
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:KLUNK
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 OAKLAND RD
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6855
Mailing Address - Country:US
Mailing Address - Phone:863-280-4123
Mailing Address - Fax:
Practice Address - Street 1:3415 W LAKE MARY BLVD # 4045
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32795-7501
Practice Address - Country:US
Practice Address - Phone:407-995-6106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVFM222925OtherFLORIDA HEALTH CARE PLAN