Provider Demographics
NPI:1730991803
Name:COONS, JASON T
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:T
Last Name:COONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 E MORSE BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7415
Mailing Address - Country:US
Mailing Address - Phone:407-270-5501
Mailing Address - Fax:
Practice Address - Street 1:4830 W KENNEDY BLVD STE 600
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2584
Practice Address - Country:US
Practice Address - Phone:407-270-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299995832251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health