Healthcare Provider Details

I. General information

NPI: 1417882762
Provider Name (Legal Business Name): JACQUELYN RENEE ARBUCKLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WATERMAN WAY
TAVARES FL
32778-5250
US

IV. Provider business mailing address

3340 WATERMAN WAY
TAVARES FL
32778-5250
US

V. Phone/Fax

Practice location:
  • Phone: 352-589-6005
  • Fax:
Mailing address:
  • Phone: 352-589-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11048451
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN11048451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: