Healthcare Provider Details

I. General information

NPI: 1225580335
Provider Name (Legal Business Name): JENNIFER MARIE ALKHALIL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE PAVAO

II. Dates (important events)

Enumeration Date: 10/25/2016
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 LAKELAND HILLS BLVD
LAKELAND FL
33805-3013
US

IV. Provider business mailing address

1600 LAKELAND HILLS BLVD
LAKELAND FL
33805-3019
US

V. Phone/Fax

Practice location:
  • Phone: 863-603-4770
  • Fax: 866-264-8519
Mailing address:
  • Phone: 863-680-7000
  • Fax: 866-264-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9297064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: