Healthcare Provider Details

I. General information

NPI: 1902058035
Provider Name (Legal Business Name): JENNA LEA WIMMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA LEA HUBNER

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 METRIC DR STE 800
WINTER PARK FL
32792-6809
US

IV. Provider business mailing address

4122 METRIC DR STE 800
WINTER PARK FL
32792-6809
US

V. Phone/Fax

Practice location:
  • Phone: 407-645-2577
  • Fax: 407-866-2793
Mailing address:
  • Phone: 407-645-2577
  • Fax: 407-866-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9254453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: