Healthcare Provider Details

I. General information

NPI: 1588800726
Provider Name (Legal Business Name): JENNIFER HEGARTY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6038 W NORDLING LOOP
CRYSTAL RIVER FL
34429-8715
US

IV. Provider business mailing address

6038 W NORDLING LOOP
CRYSTAL RIVER FL
34429-8715
US

V. Phone/Fax

Practice location:
  • Phone: 352-563-5070
  • Fax: 352-795-4322
Mailing address:
  • Phone: 352-563-5070
  • Fax: 352-795-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN252609
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: