Provider Demographics
NPI:1235527839
Name:ULLOA, ANA JAZMIN
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:JAZMIN
Last Name:ULLOA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JAZMIN
Other - Middle Name:
Other - Last Name:ULLOA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:408 JAMESTOWN DR
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3610
Mailing Address - Country:US
Mailing Address - Phone:305-484-3867
Mailing Address - Fax:
Practice Address - Street 1:408 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3610
Practice Address - Country:US
Practice Address - Phone:305-484-3867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid