Individual provider Active NPI

Jylmarie Zoe Sotomayor Cruz

  • Family Nurse Practitioner
  • Kissimmee, FL
National Provider Identifier
1861083081
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
11011312 Issued in FL
Practice address
290 Park Place Blvd
Kissimmee, FL 34741-2344
Phone
(407) 933-1221
NPI assigned
Jan 30, 2021
Last updated
Jun 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 11011312 FL Primary

Addresses

Primary practice location

290 Park Place Blvd
Kissimmee, FL 34741-2344

Mailing address

290 Park Place Blvd Kissimmee FL 34741
Davenport, FL 33896-5659
Phone (407) 933-1221

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211118003204 FL Practitioner - Nurse Practitioner 4486043098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pulmonary Disease Specialists, PAGroup PAC ID 4789648072, 6 clinicians

Practice addresses (Care Compare)

1121 N Central Ave
Kissimmee, FL 34741-4405
Phone (407) 933-1221

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
11011312FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pulmonary Disease Specialists, PA CurrentSince Aug 11, 2021 Accepting new patients

Locations

110 Park Place Blvd
Davenport, FL 33837
Phone (863) 419-0104

1121 N Central Ave
Kissimmee, FL 34741
Phone (407) 933-1221

290 Park Place Blvd
Kissimmee, FL 34741
Phone (407) 933-1221

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: jylmarie.sotomayorcruz.p1@direct.pds.nextgenshare.com

Organizations & group practices 1

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 6

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": "1611964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1861083081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 PARK PLACE BLVD KISSIMMEE FL 34741",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338965659",
            "telephone_number": "407-933-1221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 PARK PLACE BLVD",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347412344",
            "telephone_number": "407-933-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOTOMAYOR CRUZ",
        "first_name": "JYLMARIE",
        "middle_name": "ZOE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-30",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11011312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

Verify at the official NPI Registry.