Healthcare Provider Details

I. General information

NPI: 1972423218
Provider Name (Legal Business Name): JENNIFER NICOLE VINCENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26644 STATE ROAD 247
BRANFORD FL
32008-2663
US

IV. Provider business mailing address

103 US 27 W
BRANFORD FL
32008-2663
US

V. Phone/Fax

Practice location:
  • Phone: 386-984-5374
  • Fax:
Mailing address:
  • Phone: 386-984-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: