Healthcare Provider Details

I. General information

NPI: 1992642755
Provider Name (Legal Business Name): JESSICA FONSECA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

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

1900 N MILLS AVE STE 107
ORLANDO FL
32803-1460
US

IV. Provider business mailing address

743 CLAY ST APT 458
WINTER PARK FL
32789-4694
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-4880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11045208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: