Provider Demographics
NPI:1023728615
Name:FONTIN, JEAN HEROLD
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:HEROLD
Last Name:FONTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8725 WELLESLEY LAKE DR APT 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-6303
Mailing Address - Country:US
Mailing Address - Phone:407-360-7309
Mailing Address - Fax:
Practice Address - Street 1:8725 WELLESLEY LAKE DR APT 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6303
Practice Address - Country:US
Practice Address - Phone:407-360-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide