Provider Demographics
NPI:1467091959
Name:KETCHERSID, JENNIFER DOLCATER (APRN, PNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DOLCATER
Last Name:KETCHERSID
Suffix:
Gender:F
Credentials:APRN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 586
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4603
Mailing Address - Country:US
Mailing Address - Phone:407-303-6920
Mailing Address - Fax:407-303-8916
Practice Address - Street 1:2501 N ORANGE AVE STE 586
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4603
Practice Address - Country:US
Practice Address - Phone:407-303-6920
Practice Address - Fax:407-303-8916
Is Sole Proprietor?:No
Enumeration Date:2019-12-31
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005011208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics