MEDICARE: JENNIFER HUCK DNP FNP-BC AGPCNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	760200	CA
2	363LF0000X	Family Nurse Practitioner	760200	CA
3	363LG0600X	Gerontology Nurse Practitioner	760200	CA

General Provider Information

NPI Number	:	1477946903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HUCK DNP FNP-BC AGPCNP-BC

Provider Business Mailing Address
First Line	:	5185 N HIGHWAY 1
Second Line	:
City	:	PALM SHORES
State	:	FL
Zip	:	32940-7210
Country	:	US
Telephone Number	:	619-339-6506
Fax Number	:

Provider Business Practice Location Address
First Line	:	5185 N HIGHWAY 1
Second Line	:
City	:	PALM SHORES
State	:	FL
Zip	:	32940-7210
Country	:	US
Telephone Number	:	619-339-6506
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2015
Last Update Date	:	03/09/2015

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