Provider Demographics
NPI:1710734587
Name:PASSI, JATIN KUMAR
Entity type:Individual
Prefix:
First Name:JATIN
Middle Name:KUMAR
Last Name:PASSI
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 1:4325 SUN N LAKE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2171
Mailing Address - Country:US
Mailing Address - Phone:863-402-3763
Mailing Address - Fax:
Practice Address - Street 1:4325 SUN N LAKE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2171
Practice Address - Country:US
Practice Address - Phone:863-402-3763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN39399390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program