Provider Demographics
NPI:1205426467
Name:PENNY, AULECAU JACQUELINE ANN
Entity type:Individual
Prefix:MS
First Name:AULECAU
Middle Name:JACQUELINE ANN
Last Name:PENNY
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 1:1402 CALATHEA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5748
Mailing Address - Country:US
Mailing Address - Phone:407-664-4200
Mailing Address - Fax:
Practice Address - Street 1:1402 CALATHEA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-5748
Practice Address - Country:US
Practice Address - Phone:407-664-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker