Healthcare Provider Details

I. General information

NPI: 1982213872
Provider Name (Legal Business Name): JACQUELINE LEAH MUENZNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 N ORANGE AVE STE 700
ORLANDO FL
32804-5521
US

IV. Provider business mailing address

2415 N ORANGE AVE STE 700
ORLANDO FL
32804-5521
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2474
  • Fax:
Mailing address:
  • Phone: 407-303-2474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number231710
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24239
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11027423
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: