MEDICARE: DR. JENNY C JEUDI FNP-BC

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	363LF0000X	Family Nurse Practitioner	2022001273	FL
2	363LF0000X	Family Nurse Practitioner	11024928	FL

General Provider Information

NPI Number	:	1619675311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNY C JEUDI FNP-BC

Provider Business Mailing Address
First Line	:	5416 SANDBIRCH WAY
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7201
Country	:	US
Telephone Number	:	516-495-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	3450 LANTANA RD STE 100
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33462-1304
Country	:	US
Telephone Number	:	561-965-1864
Fax Number	:

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

Provider Enumeration Date	:	02/21/2023
Last Update Date	:	02/24/2023

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