Provider Demographics
NPI:1629788542
Name:ESPINOSA, JAILENE N
Entity Type:Individual
Prefix:
First Name:JAILENE
Middle Name:N
Last Name:ESPINOSA
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 1:19 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5711
Mailing Address - Country:US
Mailing Address - Phone:407-616-4441
Mailing Address - Fax:
Practice Address - Street 1:19 BROADWAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5711
Practice Address - Country:US
Practice Address - Phone:407-616-4441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program