Individual provider Active NPI

Jacqueline Vanita Boodhoo, APRN

  • Adult Health Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1376707562
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11013211 Issued in FL
Practice address
1717 S Orange Ave
Orlando, FL 32806-2944
Phone
(321) 841-4344
Fax
(321) 843-1753
NPI assigned
Jul 16, 2008
Last updated
Jan 26, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 17544 CA
Adult Health Nurse Practitioner 363LA2200X RN221717 GA
Adult Health Nurse Practitioner 363LA2200X APRN11013211 FL Primary
Registered Nurse 163W00000X 645901 CA
Gastroenterology Registered Nurse 163WG0100X RN221717 GA

Addresses

Primary practice location

1717 S Orange Ave
Orlando, FL 32806-2944

Mailing address

1717 S Orange Ave
Orlando, FL 32806-2944
Phone (321) 841-4344

Other practice location 1

661 E Altamonte Dr Ste 220
Altamonte Springs, FL 32701-5102
Phone (407) 303-5191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, FL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120820000310 GA Practitioner - Nurse Practitioner 1153577523 Reassigns benefits to 1 organization
I20210916003486 FL Practitioner - Nurse Practitioner 1153577523 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

1717 S Orange Ave
Suite 103
Orlando, FL 32806-2946
Phone (407) 236-0404

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
645901CAMDRegistered Nurse
RN221717GAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Hospital Medical Group Inc Nurse Practitioner CurrentSince Oct 25, 2021 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jan 3, 2024 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Oct 25, 2021 Accepting new patients
City of Hope Medical Group of Georgia LLC CurrentSince Feb 1, 2017 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Jan 3, 2024 Accepting new patients

Locations

661 E Altamonte Dr
Ste 220
Altamonte Springs, FL 32701
Phone (407) 303-5191

2600 Westhall Ln
Ste 4
Maitland, FL 32751
Phone (407) 200-2700

1717 S Orange Ave
Orlando, FL 32806
Phone (407) 515-2420

1717 S Orange Ave
Ste 103
Orlando, FL 32806
Phone (407) 236-0404

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

7300 Sandlake Commons Blvd
Ste 205
Orlando, FL 32819

600 Celebrate Life Pkwy
Newnan, GA 30265
Phone (404) 844-8334

62742 Collections Ctr Dr
Chicago, IL 60693

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 5

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

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1376707562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062944",
            "telephone_number": "321-841-4344",
            "fax_number": "321-843-1753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062944",
            "telephone_number": "321-841-4344",
            "fax_number": "321-843-1753"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "661 E Altamonte Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Altamonte Springs",
            "state": "FL",
            "postal_code": "327015102",
            "country_code": "US",
            "telephone_number": "407-303-5191",
            "fax_number": "407-303-5193",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOODHOO",
        "first_name": "JACQUELINE",
        "middle_name": "VANITA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-16",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "17544",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "GA",
            "license": "RN221717",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11013211",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "645901",
            "primary": false
        },
        {
            "code": "163WG0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gastroenterology",
            "state": "GA",
            "license": "RN221717",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.