Healthcare Provider Details

I. General information

NPI: 1912844762
Provider Name (Legal Business Name): JACQUELINE SUMMERALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 S ALAFAYA TRL STE 200
ORLANDO FL
32828-8956
US

IV. Provider business mailing address

117 BOYCE CT
NASHVILLE TN
37218-1905
US

V. Phone/Fax

Practice location:
  • Phone: 407-961-6229
  • Fax: 833-528-6509
Mailing address:
  • Phone: 407-961-6229
  • Fax: 833-528-6509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number51480
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: