Healthcare Provider Details

I. General information

NPI: 1598141236
Provider Name (Legal Business Name): JEFFRY P GOLD AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 DYLAN LOREN CIR STE 102
ORLANDO FL
32825-4437
US

IV. Provider business mailing address

10800 DYLAN LOREN CIR STE 102
ORLANDO FL
32825-4437
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-8665
  • Fax: 407-277-1267
Mailing address:
  • Phone: 407-277-8665
  • Fax: 407-277-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13486
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9262011
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024184216
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024184216
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number13486
License Number StateWI
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number13486
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: