Healthcare Provider Details

I. General information

NPI: 1205239944
Provider Name (Legal Business Name): JENNIFER GEE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2014
Last Update Date: 11/03/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 ELDRON BLVD SE
PALM BAY FL
32909-6813
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-312-3473
  • Fax: 321-409-6813
Mailing address:
  • Phone: 321-312-3473
  • Fax: 321-409-6813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9383919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: