Provider Demographics
NPI:1962395392
Name:FLATTEN, JACOB ALLEN (AGAC-DNP)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:ALLEN
Last Name:FLATTEN
Suffix:
Gender:M
Credentials:AGAC-DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1110
Mailing Address - Country:US
Mailing Address - Phone:407-648-3800
Mailing Address - Fax:407-872-7754
Practice Address - Street 1:22 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:407-648-3800
Practice Address - Fax:407-872-7754
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2465074163WG0000X
FLAPRN11040471363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL129019200Medicaid