MEDICARE: MRS. JENNY AMBER VEVEA MINACCI APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner	11043333	FL

General Provider Information

NPI Number	:	1407711211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNY AMBER VEVEA MINACCI APRN

Provider Business Mailing Address
First Line	:	9860 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4704
Country	:	US
Telephone Number	:	907-807-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	9860 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4704
Country	:	US
Telephone Number	:	907-807-9112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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