Healthcare Provider Details

I. General information

NPI: 1700730850
Provider Name (Legal Business Name): PRIMARY PATHWAY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2367 EL MARRA DR
OCOEE FL
34761-8414
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 321-399-2486
  • Fax: 321-221-5343
Mailing address:
  • Phone: 321-399-2486
  • Fax: 321-221-5343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BERTINE JEANLAURENT
Title or Position: CLINICAL DIRECTOR
Credential: APRN, FNP-BC
Phone: 321-399-2486