Healthcare Provider Details

I. General information

NPI: 1467371542
Provider Name (Legal Business Name): JENNIFER JONITA FRIEDERICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 N MAITLAND AVE STE 1020
MAITLAND FL
32751-3320
US

IV. Provider business mailing address

424 BRIDLE PATH
CASSELBERRY FL
32707-3142
US

V. Phone/Fax

Practice location:
  • Phone: 407-741-5400
  • Fax: 407-629-6096
Mailing address:
  • Phone: 407-741-5400
  • Fax: 407-629-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9696409
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: