Healthcare Provider Details

I. General information

NPI: 1356126577
Provider Name (Legal Business Name): JENIFER LYNN RAYMOND PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2023
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 FRANKLIN DR NE
PALM BAY FL
32905-4022
US

IV. Provider business mailing address

7625 WALNUT WAY UNIT 4209
MELBOURNE FL
32940-2864
US

V. Phone/Fax

Practice location:
  • Phone: 321-724-1614
  • Fax:
Mailing address:
  • Phone: 860-420-8972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11028382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: