Healthcare Provider Details

I. General information

NPI: 1437749116
Provider Name (Legal Business Name): JENNIFER GILMARTIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 CYPRESS POINT PKWY STE D102
PALM COAST FL
32164-8445
US

IV. Provider business mailing address

1048 W SAMMS AVE
PORT ORANGE FL
32129-4168
US

V. Phone/Fax

Practice location:
  • Phone: 386-230-4448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11046424
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9554552
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: