=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154395739
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH A JENNINGS A.R.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2006
-----------------------------------------------------
Last Update Date | 12/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5640 MAIN ST
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-841-4425
-----------------------------------------------------
Fax | 727-816-1956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5640 MAIN ST
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-841-4425
-----------------------------------------------------
Fax | 727-816-1956
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | ARNP1146562
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------