Provider Demographics
NPI:1114681525
Name:CAUDILL, JENSINE LARGADO (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENSINE
Middle Name:LARGADO
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 ROBIN HOLLY ST
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5340
Mailing Address - Country:US
Mailing Address - Phone:321-948-2173
Mailing Address - Fax:
Practice Address - Street 1:2716 REW CIR STE 100
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4201
Practice Address - Country:US
Practice Address - Phone:407-347-0666
Practice Address - Fax:407-347-0570
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014797363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily