Provider Demographics
NPI:1215689112
Name:JARVIS, JEVONNA A
Entity type:Individual
Prefix:
First Name:JEVONNA
Middle Name:A
Last Name:JARVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 ALBENGA AVE # UV2-201B
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-4000
Mailing Address - Country:US
Mailing Address - Phone:678-896-3841
Mailing Address - Fax:
Practice Address - Street 1:5930 NW PINE TRAIL CIR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-5346
Practice Address - Country:US
Practice Address - Phone:678-896-3841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer