Healthcare Provider Details

I. General information

NPI: 1700267689
Provider Name (Legal Business Name): JENNIFER MEAD UEBELE MSN-ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JENNIFER GAYLE MEAD

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MINE LAKE CT STE 200
RALEIGH NC
27615
US

IV. Provider business mailing address

3800 S OCEAN DR STE 209
HOLLYWOOD FL
33019-2915
US

V. Phone/Fax

Practice location:
  • Phone: 305-466-9988
  • Fax:
Mailing address:
  • Phone: 305-466-9988
  • Fax: 305-466-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5009081
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009081
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: