Healthcare Provider Details

I. General information

NPI: 1538813530
Provider Name (Legal Business Name): JENNIFER CUELLAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27511 SKY LAKE CIR
WESLEY CHAPEL FL
33544-7644
US

IV. Provider business mailing address

27511 SKY LAKE CIR
WESLEY CHAPEL FL
33544-7644
US

V. Phone/Fax

Practice location:
  • Phone: 813-997-1442
  • Fax:
Mailing address:
  • Phone: 813-997-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9386548
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9386548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: