Healthcare Provider Details

I. General information

NPI: 1548503105
Provider Name (Legal Business Name): JESSIE CIROLIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 PRIMERA BLVD STE 145
LAKE MARY FL
32746-2130
US

IV. Provider business mailing address

725 PRIMERA BLVD STE 145
LAKE MARY FL
32746-2130
US

V. Phone/Fax

Practice location:
  • Phone: 321-472-3200
  • Fax:
Mailing address:
  • Phone: 321-472-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9309603
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9309603
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: