Healthcare Provider Details

I. General information

NPI: 1356218051
Provider Name (Legal Business Name): JAZMIN LASSALLE-PALLENS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2025
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 ORIENTA AVE
ALTAMONTE SPRINGS FL
32701-5619
US

IV. Provider business mailing address

985 STATE ROAD 436
CASSELBERRY FL
32707-5664
US

V. Phone/Fax

Practice location:
  • Phone: 407-339-2910
  • Fax: 321-972-3467
Mailing address:
  • Phone: 407-831-5252
  • Fax: 407-831-3765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11042646
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: