=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962984104
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNELYN IPO MONEDA APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2018
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14100 FIVAY RD STE 130
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34667-7159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-857-4871
-----------------------------------------------------
Fax | 727-857-4894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5400 PINEHURST DR
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-3833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-277-5348
-----------------------------------------------------
Fax | 352-606-2857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9325543
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------