Individual
MR. JACK FACUNDUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
651 W WARREN AVE STE 100, LONGWOOD, FL 32750-4036
(321) 999-9617
Mailing address
5151 ADANSON ST, ORLANDO, FL 32804-1317
(407) 875-3700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
090740-23
NH
363LF0000X
Family Nurse Practitioner
ARNP2824142
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN2824142
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ARNP2824142
STATE OF FLORIDA ARNP LICENSE
FL
01
—
F0416038
AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION PROGRAM
FL
Enumeration date
09/26/2016
Last updated
06/14/2024
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