Healthcare Provider Details

I. General information

NPI: 1316784598
Provider Name (Legal Business Name): JENNIFER SUE TRIKONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 FORTENBERRY RD
MERRITT ISLAND FL
32952-3616
US

IV. Provider business mailing address

1701 HIGHWAY A1A STE 300
VERO BEACH FL
32963-2263
US

V. Phone/Fax

Practice location:
  • Phone: 561-320-0996
  • Fax:
Mailing address:
  • Phone: 561-320-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11034659
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9432245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: