Healthcare Provider Details

I. General information

NPI: 1568003465
Provider Name (Legal Business Name): JESSICA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7652 ASHLEY PARK CT STE 306
ORLANDO FL
32835-6199
US

IV. Provider business mailing address

11040 TORTUGA BND APT 201
ORLANDO FL
32825-6168
US

V. Phone/Fax

Practice location:
  • Phone: 407-299-7333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11000151
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: