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General NPI Number Information
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NPI Number | 1497160360
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Entity Type | Organization
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Legal Business Name | JENNEWEIN, NP-C, LLC
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 40 WASHINGTON STREET
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City | FREEPORT
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State | FL
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Zip | 32439
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Country | US
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Telephone | 850-240-9023
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Fax |
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Provider Business Mailing Address
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Address Line | 722 RODNEY AVE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547
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Country | US
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Telephone | 850-240-9023
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | CHERRI JENNEWEIN
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Credential | ARNP, NP-C
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Telephone | 850-240-9023
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 9233360
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9233360
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License Number State | FL
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