Individual
JACQUELIN VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1307 CRANE CREST WAY, ORLANDO, FL 32825-4419
(407) 241-9971
Mailing address
9919 CYPRESS KNEE CIR, ORLANDO, FL 32825-9107
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PACN96
FL
363AM0700X
Medical Physician Assistant
10098
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10098
—
AZ
01
—
246ZC0007X
FIRST SURGICAL ASSISTANT
FL
05
—
PACN96
—
FL
Enumeration date
07/06/2016
Last updated
11/25/2025
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