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General NPI Number Information
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NPI Number | 1851743504
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Entity Type | Individual
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Provider Name | JACQUELIN VINCENT
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Gender | Male
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 11/25/2025
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Provider Practice Location Address
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Address Line | 1307 CRANE CREST WAY
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City | ORLANDO
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State | FL
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Zip | 32825-4419
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Country | US
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Telephone | 407-241-9971
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Fax |
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Provider Business Mailing Address
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Address Line | 9919 CYPRESS KNEE CIR
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City | ORLANDO
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State | FL
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Zip | 32825-9107
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10098
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PACN96
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License Number State | FL
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