Healthcare Provider Details

I. General information

NPI: 1982999850
Provider Name (Legal Business Name): JENNA NICOLE CERVI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 06/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8455 N WICKHAM RD T-1934
VIERA FL
32940-6607
US

IV. Provider business mailing address

8455 N WICKHAM RD T-1934
VIERA FL
32940-6607
US

V. Phone/Fax

Practice location:
  • Phone: 321-752-1870
  • Fax: 321-752-1870
Mailing address:
  • Phone: 321-752-1870
  • Fax: 321-752-1870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: