Healthcare Provider Details

I. General information

NPI: 1194521740
Provider Name (Legal Business Name): AUDREY JONES SPEARS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

821 E 26TH AVE
NEW SMYRNA FL
32169-3615
US

V. Phone/Fax

Practice location:
  • Phone: 352-360-5755
  • Fax:
Mailing address:
  • Phone: 352-360-5755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN9294105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: