Healthcare Provider Details

I. General information

NPI: 1831806637
Provider Name (Legal Business Name): JENNIFER FAVOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100118
GAINESVILLE FL
32610-0118
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0606
  • Fax:
Mailing address:
  • Phone: 352-265-0761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11020433
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11020433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: