Healthcare Provider Details

I. General information

NPI: 1225958077
Provider Name (Legal Business Name): JENNY SOTOLONGO APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 HOWARD ST E
LIVE OAK FL
32064-3401
US

IV. Provider business mailing address

7873 133RD RD
LIVE OAK FL
32060-8867
US

V. Phone/Fax

Practice location:
  • Phone: 386-320-6900
  • Fax:
Mailing address:
  • Phone: 786-389-6193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11049297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: