Healthcare Provider Details

I. General information

NPI: 1902449606
Provider Name (Legal Business Name): HECTOR JAIME FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 WINTER SPRINGS BLVD
WINTER SPGS FL
32708-3801
US

IV. Provider business mailing address

1304 WINTER SPRINGS BLVD
WINTER SPGS FL
32708-3801
US

V. Phone/Fax

Practice location:
  • Phone: 321-439-7775
  • Fax:
Mailing address:
  • Phone: 321-439-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11004780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: