MEDICARE: JENNIFER GILMARTIN RN

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	163W00000X	Registered Nurse	9554552	FL

General Provider Information

NPI Number	:	1437749116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER GILMARTIN RN

Provider Business Mailing Address
First Line	:	1048 W SAMMS AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4168
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 W SAMMS AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-4168
Country	:	US
Telephone Number	:	386-316-7168
Fax Number	:

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

Provider Enumeration Date	:	01/26/2021
Last Update Date	:	01/26/2021

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