Active NPI
Jennifer Fullwood
- Clinical Social Worker
- Orlando, FL
National Provider Identifier
1184290876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 5115 Anzio St
Orlando, FL 32819-8407 - Phone
- (321) 290-0898
- NPI assigned
- Jun 2, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | Primary |
Addresses
Primary practice location
5115 Anzio St
Orlando, FL 32819-8407
Mailing address
2531 Settlers TRL
Saint Cloud, FL 34772-8514
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1622592000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622592000000",
"number": "1184290876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2531 SETTLERS TRL",
"city": "SAINT CLOUD",
"state": "FL",
"postal_code": "347728514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5115 ANZIO ST",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328198407",
"telephone_number": "321-290-0898"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLWOOD",
"first_name": "JENNIFER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-02",
"last_updated": "2021-06-02",
"certification_date": "2021-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.