Active NPI
Jaclyn Nicole Rentz, PA-C
- Physician Assistant
- Orlando, FL
National Provider Identifier
1396421525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 53580
- Practice address
- 12612 Challenger Pkwy Ste 365
Orlando, FL 32826-2784 - Phone
- (407) 306-8441
- NPI assigned
- Jun 22, 2023
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 53580 | CA | Primary |
Addresses
Primary practice location
12612 Challenger Pkwy Ste 365
Orlando, FL 32826-2784
Mailing address
12845 Pinefield Rd
Poway, CA 92064-1501
Phone (951) 906-6093
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 53580 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687392000000",
"number": "1396421525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12845 PINEFIELD RD",
"city": "POWAY",
"state": "CA",
"postal_code": "920641501",
"telephone_number": "951-906-6093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12612 CHALLENGER PKWY STE 365",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328262784",
"telephone_number": "407-306-8441"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENTZ",
"first_name": "JACLYN",
"middle_name": "NICOLE",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-06-22",
"last_updated": "2023-06-22",
"certification_date": "2023-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "53580",
"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 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.