Organization
IVPS OF KISSIMMEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENEANE WAKULA (OFFICE MANAGER)
(772) 546-9591
Entity
Organization
Contact information
Practice address
201 RUBY AVE STE C, KISSIMMEE, FL 34741-5699
(772) 546-9591
Mailing address
8929 SE BRIDGE RD, HOBE SOUND, FL 33455-5312
(772) 546-9591
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
FL
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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