Individual
MR. JARVIN VINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7215 JONQUIL DR, ORLANDO, FL 32818-5808
(407) 305-1925
Mailing address
7215 JONQUIL DR, ORLANDO, FL 32818-5808
(407) 305-1925
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
FL
320700000X
Physical Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
670200
—
FL
Enumeration date
05/24/2017
Last updated
07/22/2024
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