Individual
KENNETH OLIVER JERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
13800 VETERANS WAY, ORLANDO, FL 32827-7401
(407) 631-3100
Mailing address
14927 TWINBERRY DR, ORLANDO, FL 32828-7332
(407) 902-1764
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
11022086
FL
Other
Enumeration date
10/18/2022
Last updated
10/18/2022
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