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General NPI Number Information
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NPI Number | 1467038240
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Entity Type | Individual
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Provider Name | JENNIFER RICKS ERVIN ARNP
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 2060 HIGHWAY A1A STE 304
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City | INDIAN HARBOUR BEACH
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State | FL
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Zip | 32937-3596
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Country | US
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Telephone | 904-813-9485
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Fax |
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Provider Business Mailing Address
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Address Line | 4480 PHILODENDRON CT
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City | MELBOURNE
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State | FL
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Zip | 32934-8612
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Country | US
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Telephone | 904-813-9485
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 11011762
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License Number State | FL
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