Healthcare Provider Details

I. General information

NPI: 1144520610
Provider Name (Legal Business Name): JEANIQUE MICHELLE JACQUES LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7808 LAKESIDE WOODS DRIVE
ORLANDO FL
32810
US

IV. Provider business mailing address

7808 LAKESIDE WOODS DRIVE
ORLANDO FL
32810
US

V. Phone/Fax

Practice location:
  • Phone: 407-294-9593
  • Fax:
Mailing address:
  • Phone: 407-294-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9667268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: