Healthcare Provider Details

I. General information

NPI: 1467091959
Provider Name (Legal Business Name): JENNIFER DOLCATER KETCHERSID APRN, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 586
ORLANDO FL
32804-4603
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 586
ORLANDO FL
32804-4603
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-6920
  • Fax: 407-303-8916
Mailing address:
  • Phone: 407-303-6920
  • Fax: 407-303-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN11005011
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: