MEDICARE: JENNY KIM NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	APRN11041465	FL

General Provider Information

NPI Number	:	1942168794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY KIM NP

Provider Business Mailing Address
First Line	:	601 E ROLLINS ST, ORLANDO, FL 32803
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803
Country	:	US
Telephone Number	:	407-303-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E ROLLINS ST, ORLANDO
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803
Country	:	US
Telephone Number	:	407-303-5600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	06/24/2026

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