Healthcare Provider Details

I. General information

NPI: 1972833010
Provider Name (Legal Business Name): JENNIFER ANN LIEVANO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 4TH ST N STE 14102
ST PETERSBURG FL
33702-4305
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 813-280-0124
  • Fax: 904-341-5249
Mailing address:
  • Phone: 321-361-5573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2730622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: