Healthcare Provider Details

I. General information

NPI: 1609707942
Provider Name (Legal Business Name): JERILYN BOYLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S WEST CROWN POINT RD STE 150
WINTER GARDEN FL
34787-2917
US

IV. Provider business mailing address

1994 JENNY CT
APOPKA FL
32703-7635
US

V. Phone/Fax

Practice location:
  • Phone: 407-905-8908
  • Fax:
Mailing address:
  • Phone: 352-540-0168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberB400-433-97-867-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: