Healthcare Provider Details

I. General information

NPI: 1912682493
Provider Name (Legal Business Name): JENNA LOGAN ERIKSON DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA LOGAN SCHUPPENER

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9970 CENTRAL PARK BLVD N STE 207
BOCA RATON FL
33428-2236
US

IV. Provider business mailing address

9960 NW 116TH WAY STE 13
MEDLEY FL
33178-1175
US

V. Phone/Fax

Practice location:
  • Phone: 561-428-1027
  • Fax: 561-428-1028
Mailing address:
  • Phone: 786-924-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11024924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: