Provider Demographics
NPI:1699251389
Name:HERRERA, JEFFREY (LAC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 PEAR TREE CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-6460
Mailing Address - Country:US
Mailing Address - Phone:407-257-0948
Mailing Address - Fax:
Practice Address - Street 1:200 N DENNING DR STE 7
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3736
Practice Address - Country:US
Practice Address - Phone:407-900-7145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3150171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist