Healthcare Provider Details

I. General information

NPI: 1962395392
Provider Name (Legal Business Name): JACOB ALLEN FLATTEN AGAC-DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

22 UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-3800
  • Fax: 407-872-7754
Mailing address:
  • Phone: 407-648-3800
  • Fax: 407-872-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2465074
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11040471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: