Healthcare Provider Details

I. General information

NPI: 1720700529
Provider Name (Legal Business Name): JENNIFER REEVES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNY DEARTH

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

2428 JENKS AVE STE B
PANAMA CITY FL
32405-4304
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5974
  • Fax:
Mailing address:
  • Phone: 850-215-4171
  • Fax: 850-215-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71016872A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11021732
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: