Provider Demographics
NPI:1497474910
Name:ESTRADA, JENNIFER H
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:H
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S DENNING DR APT 132
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5668
Mailing Address - Country:US
Mailing Address - Phone:407-613-4824
Mailing Address - Fax:
Practice Address - Street 1:1250 S DENNING DR APT 132
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5668
Practice Address - Country:US
Practice Address - Phone:407-613-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver