Healthcare Provider Details

I. General information

NPI: 1790311215
Provider Name (Legal Business Name): JENNIFER LINDSEY SEVILLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LINDSEY MEYER

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 N BELCHER RD STE F1
CLEARWATER FL
33765-1453
US

IV. Provider business mailing address

1103 15TH ST
PALM HARBOR FL
34683-4108
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-4544
  • Fax: 727-726-4618
Mailing address:
  • Phone: 727-415-0872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11006411
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: