Healthcare Provider Details

I. General information

NPI: 1902542152
Provider Name (Legal Business Name): JARRETT HAYLES-PATTERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 SIMPSON RD
KISSIMMEE FL
34744-5328
US

IV. Provider business mailing address

3632 CORD AVE
SAINT CLOUD FL
34772-8033
US

V. Phone/Fax

Practice location:
  • Phone: 407-483-5757
  • Fax: 855-642-2122
Mailing address:
  • Phone: 973-508-9572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11037184
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: