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NPI Code Detail

MEDICARE: SALESHE JATICO APRN

MEDICARE: SALESHE JATICO APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN11027277FL

General Provider Information

NPI Number : 1174956981
Entity Type Code : Individual
Provider Name (Legal Business Name) : SALESHE JATICO APRN
Provider Business Mailing Address
First Line : 206 PARK PLACE BLVD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34741-2344
Country : US
Telephone Number : 407-846-0023
Fax Number : 407-988-0937
Provider Business Practice Location Address
First Line : 206 PARK PLACE BLVD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34741-2344
Country : US
Telephone Number : 407-846-0023
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2013
Last Update Date : 02/02/2026

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