Healthcare Provider Details

I. General information

NPI: 1295661585
Provider Name (Legal Business Name): ROSENDO DE JESUS URENA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 POND CT STE 301
DEBARY FL
32713-2717
US

IV. Provider business mailing address

110 POND CT STE 301
DEBARY FL
32713-2717
US

V. Phone/Fax

Practice location:
  • Phone: 386-259-4258
  • Fax: 877-569-2113
Mailing address:
  • Phone: 386-259-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11046867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: