Healthcare Provider Details

I. General information

NPI: 1669890505
Provider Name (Legal Business Name): JENNIFER LYNN TAYLOR APRN, CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LYNN GREEN

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 310
ORLANDO FL
32804-4642
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 310
ORLANDO FL
32804-4642
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2001
  • Fax: 407-303-2450
Mailing address:
  • Phone: 407-303-2001
  • Fax: 407-303-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License NumberAPRN9264341
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9264341
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: