Provider Demographics
NPI:1083009328
Name:LARREA, JACQUELINE BONNY (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:BONNY
Last Name:LARREA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1853
Mailing Address - Country:US
Mailing Address - Phone:407-896-1726
Mailing Address - Fax:407-241-3259
Practice Address - Street 1:1817 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1853
Practice Address - Country:US
Practice Address - Phone:407-896-1726
Practice Address - Fax:407-241-3259
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9263016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily