Individual
JEAN WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
665 MADRID DR, KISSIMMEE, FL 34758-3342
(407) 846-7419
Mailing address
665 MADRID DR, KISSIMMEE, FL 34758-3342
(407) 846-7419
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
Primary
09124200407
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230258600
—
FL
Enumeration date
05/01/2008
Last updated
05/01/2008
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