Healthcare Provider Details

I. General information

NPI: 1528834165
Provider Name (Legal Business Name): MONICA JENNIGES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NOLAND DR
BRANDON FL
33511-5719
US

IV. Provider business mailing address

4210 W BIRD ST
TAMPA FL
33614-2506
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11051304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: