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General NPI Number Information
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NPI Number | 1184127888
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Entity Type | Individual
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Provider Name | JENNA MADHAVAN MSN, ARNP, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/09/2018
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 119 OAKFIELD DR
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City | BRANDON
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State | FL
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Zip | 33511-5779
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Country | US
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Telephone | 813-681-5551
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Fax |
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Provider Business Mailing Address
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Address Line | 11506 LEANNE LN
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City | TAMPA
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State | FL
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Zip | 33637-2725
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Country | US
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Telephone | 813-545-0133
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9370721
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License Number State | FL
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