Healthcare Provider Details

I. General information

NPI: 1952797680
Provider Name (Legal Business Name): JACQUELINE HUTTNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 04/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 N ORANGE BLOSSOM TRL
ORLANDO FL
32805-1612
US

IV. Provider business mailing address

232 N ORANGE BLOSSOM TRL
ORLANDO FL
32805-1612
US

V. Phone/Fax

Practice location:
  • Phone: 407-428-5751
  • Fax: 407-447-7245
Mailing address:
  • Phone: 407-428-5751
  • Fax: 407-447-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN9299148
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: