Healthcare Provider Details

I. General information

NPI: 1902382468
Provider Name (Legal Business Name): JILLIAN LEIGH JERNIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5810 HIGHWAY 189 N
BAKER FL
32531-2506
US

IV. Provider business mailing address

5300 OLD RIVER RD
BAKER FL
32531-9303
US

V. Phone/Fax

Practice location:
  • Phone: 850-273-8181
  • Fax: 904-515-5795
Mailing address:
  • Phone: 850-305-9733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP9264700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: