Provider Demographics
NPI:1497134977
Name:SERRANO, JERRY (ARNP)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 S HIAWASSEE RD
Mailing Address - Street 2:STE 107
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-5706
Mailing Address - Country:US
Mailing Address - Phone:407-228-2804
Mailing Address - Fax:407-228-2806
Practice Address - Street 1:2316 HILLCREST ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4900
Practice Address - Country:US
Practice Address - Phone:407-228-2804
Practice Address - Fax:407-228-2806
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9181064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF0315470OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
FLARNP9181064OtherARNP LICENSE