Healthcare Provider Details

I. General information

NPI: 1568955441
Provider Name (Legal Business Name): JARED H UMLAND PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 288
OCOEE FL
34761-3432
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 288
OCOEE FL
34761-3432
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-8900
  • Fax: 321-843-8916
Mailing address:
  • Phone: 321-843-8900
  • Fax: 321-843-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-790
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3352
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9120288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: