Provider Demographics
NPI:1013722883
Name:MANZANILLA, JENNIFER CAROLINA (FNP-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROLINA
Last Name:MANZANILLA
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4936
Mailing Address - Country:US
Mailing Address - Phone:407-933-2775
Mailing Address - Fax:407-933-8549
Practice Address - Street 1:737 W OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4936
Practice Address - Country:US
Practice Address - Phone:407-933-2775
Practice Address - Fax:407-933-8549
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11038109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily