Healthcare Provider Details

I. General information

NPI: 1285172379
Provider Name (Legal Business Name): KRISSY ANN JIANG CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISSY ANN FILCHECK CPNP-AC

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13535 NEMOURS PKWY
ORLANDO FL
32827-7402
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-4000
  • Fax:
Mailing address:
  • Phone: 46-697-4127
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number865389
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9494254
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: