Individual provider Active NPI

Jaclyn Ann Gunn, D.O.

  • Family Medicine Physician
  • Winter Garden, FL
National Provider Identifier
1639548654
Registry record updated Jan 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS15657 Issued in FL
Practice address
2000 Fowler Grove Blvd FL 3
Winter Garden, FL 34787-5050
Phone
(407) 614-0528
Fax
(407) 614-0529
NPI assigned
Sep 21, 2015
Last updated
Jan 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS15657 FL Primary

Addresses

Primary practice location

2000 Fowler Grove Blvd FL 3
Winter Garden, FL 34787-5050

Mailing address

2000 Fowler Grove Blvd FL 3
Winter Garden, FL 34787-5050
Phone (407) 614-0528

Other names 1

  • Jaclyn Ann Lazaro Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190115001419 FL Practitioner - Family Practice 9335431931 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia School of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Adventhealth Primary Care Network IncGroup PAC ID 1557722410, 428 clinicians

Practice addresses (Care Compare)

2200 Fowler Grove Blvd
Suite 140
Winter Garden, FL 34787-5597
Phone (407) 614-0528

661 E Altamonte Dr
Suite 115
Altamonte Springs, FL 32701-5102
Phone (407) 831-4040

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Adventhealth Primary Care Network Inc Family Medicine CurrentSince Aug 1, 2023 Accepting new patients
Florida Hospital Medical Group Inc Family Medicine CurrentSince Jan 7, 2019 Accepting new patients
Florida Hospital Medical Group Inc CurrentSince Jan 7, 2019 Accepting new patients

Locations

661 E Altamonte Dr
Ste 115
Altamonte Springs, FL 32701
Phone (407) 831-4040

900 Hope Way
Forest City, FL 32714
Phone (407) 357-1255

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

2000 Fowler Grove Blvd
Fl 3
Winter Garden, FL 34787
Phone (407) 521-3600

2200 Fowler Grove Blvd
Ste 140
Winter Garden, FL 34787
Phone (407) 614-0528

Interoperability endpoints

  • Direct secure messaging: jgunn73073@adventhealth.direct-ci.com

Organizations & group practices 3

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 3

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": "1442793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547510400000",
    "number": "1639548654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 FOWLER GROVE BLVD FL 3",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347875050",
            "telephone_number": "407-614-0528",
            "fax_number": "407-614-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 FOWLER GROVE BLVD FL 3",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347875050",
            "telephone_number": "407-614-0528",
            "fax_number": "407-614-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUNN",
        "first_name": "JACLYN",
        "middle_name": "ANN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-21",
        "last_updated": "2019-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS15657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACLYN",
            "last_name": "LAZARO",
            "middle_name": "ANN",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Winter Garden, FL

Sources for this page

Verify at the official NPI Registry.