Provider Demographics
NPI:1114816444
Name:DE LA CRUZ SOTO, JACKELINE (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:JACKELINE
Middle Name:
Last Name:DE LA CRUZ SOTO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 HARDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-8290
Mailing Address - Country:US
Mailing Address - Phone:407-461-1692
Mailing Address - Fax:
Practice Address - Street 1:529 HARDWOOD CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-8290
Practice Address - Country:US
Practice Address - Phone:407-461-1692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9497683163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health