Provider Demographics
NPI:1780209023
Name:QUINTANA, JAZMINE RACHEL (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JAZMINE
Middle Name:RACHEL
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 SAND LAKE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809
Mailing Address - Country:US
Mailing Address - Phone:407-851-5121
Mailing Address - Fax:407-851-0439
Practice Address - Street 1:2345 SAND LAKE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809
Practice Address - Country:US
Practice Address - Phone:407-851-5121
Practice Address - Fax:407-851-0439
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114199363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program