Healthcare Provider Details

I. General information

NPI: 1760262000
Provider Name (Legal Business Name): JENELLE MARIE SULEYMAN APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 NE 5TH ST
CRYSTAL RIVER FL
34429
US

IV. Provider business mailing address

717 NE 5TH ST
CRYSTAL RIVER FL
34429-4325
US

V. Phone/Fax

Practice location:
  • Phone: 352-212-7910
  • Fax: 352-204-1449
Mailing address:
  • Phone: 352-212-7910
  • Fax: 352-204-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN9435912
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029748
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: