Provider Demographics
NPI:1558321133
Name:ROY, JASON (ARNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:ROY
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 1:3885 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6257
Mailing Address - Country:US
Mailing Address - Phone:407-851-5600
Mailing Address - Fax:407-438-9585
Practice Address - Street 1:9430 TURKEY LAKE RD
Practice Address - Street 2:STE 206
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8015
Practice Address - Country:US
Practice Address - Phone:407-851-5600
Practice Address - Fax:407-438-9585
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2905452363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4949ZMedicare ID - Type Unspecified
FLP21029Medicare UPIN