Jenalyn Victoria Licea, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11020852 Issued in FL

Practice address

2050 Farm Way
Middleburg, FL 32068-6796

Phone

(864) 334-7227

NPI assigned

Jul 19, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Optimal Holistic Medicine

  • Family Nurse Practitioner
  • Middleburg, FL
  • NPI 1679458988
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1658188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1376278978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 FARM WAY",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320686796",
            "telephone_number": "864-334-7227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 FARM WAY",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320686796",
            "telephone_number": "864-334-7227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICEA",
        "first_name": "JENALYN",
        "middle_name": "VICTORIA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-19",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11020852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Legacy Family Healthcare Inc
• Kristen Leino, APRN
• Kelly J. Lemaire, MD
• Renee Ayala Lerner, DDS
• Cynthia Hailey Letterman, RN
• Rodney Wayne Lich, LAT/ATC
• Briana Little
• Christopher Littles
• Livality Integrated Health
• Mikhail Lobatos, LMHC

• Family Nurse Practitioner in Middleburg, FL
• Providers in Middleburg, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.