Provider Demographics
NPI:1992293245
Name:HALL, JAMAR SR
Entity type:Individual
Prefix:
First Name:JAMAR
Middle Name:
Last Name:HALL
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JAMAR
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8112 CENTRALIA CT
Mailing Address - Street 2:
Mailing Address - City:LEESBURG FL
Mailing Address - State:FL
Mailing Address - Zip Code:34788
Mailing Address - Country:US
Mailing Address - Phone:352-874-3643
Mailing Address - Fax:
Practice Address - Street 1:2858 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4631
Practice Address - Country:US
Practice Address - Phone:813-957-8327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022093700Medicaid