Healthcare Provider Details

I. General information

NPI: 1114681525
Provider Name (Legal Business Name): JENSINE LARGADO CAUDILL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 289
OCOEE FL
34761-3432
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 289
OCOEE FL
34761-3432
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-4765
  • Fax: 321-842-4767
Mailing address:
  • Phone: 321-842-4765
  • Fax: 321-842-4767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11014797
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11014797
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: