Provider Demographics
NPI:1154402816
Name:PESTANA, JASPREET KAUR (MD)
Entity type:Individual
Prefix:DR
First Name:JASPREET
Middle Name:KAUR
Last Name:PESTANA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JASPREET
Other - Middle Name:KAUR
Other - Last Name:BHULLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613
Practice Address - Country:US
Practice Address - Phone:813-974-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96774207RG0300X, 207RG0300X
SC40006207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSCA241E243OtherMCARE PTAN
SC400061Medicaid
FL279032700Medicaid
SC400061Medicaid
FLAE804ZMedicare Oscar/Certification