Provider Demographics
NPI:1043108244
Name:JACQUES, ISLANDE X
Entity type:Individual
Prefix:
First Name:ISLANDE
Middle Name:X
Last Name:JACQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 NEWHALL AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-4948
Mailing Address - Country:US
Mailing Address - Phone:407-928-1568
Mailing Address - Fax:
Practice Address - Street 1:326 N POWERS DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-1224
Practice Address - Country:US
Practice Address - Phone:407-928-1568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach