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General NPI Number Information
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NPI Number | 1962395392
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Entity Type | Individual
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Provider Name | JACOB ALLEN FLATTEN AGAC-DNP
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Gender | Male
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 22 UNDERWOOD ST
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City | ORLANDO
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State | FL
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Zip | 32806-1110
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Country | US
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Telephone | 407-648-3800
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Fax | 407-872-7754
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Provider Business Mailing Address
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Address Line | 22 UNDERWOOD ST
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City | ORLANDO
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State | FL
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Zip | 32806-1110
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Country | US
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Telephone | 407-648-3800
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Fax | 407-872-7754
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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 | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 2465074
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | APRN11040471
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License Number State | FL
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