Provider Demographics
NPI:1558837310
Name:SAUMELL ROSALES, JERRYLEE (FNP)
Entity type:Individual
Prefix:
First Name:JERRYLEE
Middle Name:
Last Name:SAUMELL ROSALES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7243 DELLA DR
Mailing Address - Street 2:3RD FL STE K
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5106
Mailing Address - Country:US
Mailing Address - Phone:407-381-7366
Mailing Address - Fax:321-203-4625
Practice Address - Street 1:7243 DELLA DR
Practice Address - Street 2:3RD FL STE K
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5106
Practice Address - Country:US
Practice Address - Phone:407-381-7366
Practice Address - Fax:321-203-4625
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9363061363L00000X
FLAPRN9363061363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101376300Medicaid