Healthcare Provider Details

I. General information

NPI: 1043108244
Provider Name (Legal Business Name): ISLANDE X JACQUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 N POWERS DR
ORLANDO FL
32835-1224
US

IV. Provider business mailing address

5304 NEWHALL AVE
ORLANDO FL
32810-4948
US

V. Phone/Fax

Practice location:
  • Phone: 407-928-1568
  • Fax:
Mailing address:
  • Phone: 407-928-1568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: