Provider Demographics
NPI:1124597463
Name:CEREIJO BARREDA, ERNESTO JESUS SR (APRN)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:JESUS
Last Name:CEREIJO BARREDA
Suffix:SR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:900 S GOLDENROD RD STE B
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8113
Practice Address - Country:US
Practice Address - Phone:407-362-0148
Practice Address - Fax:407-271-8436
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11000128363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF10181313OtherAMERICAN ASSOC OF NURSR PRACTITIONERS