MEDICARE: JENNIFER C JEAN APRN

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	163W00000X	Registered Nurse	9506400	FL
2	363L00000X	Nurse Practitioner	11042277	FL

General Provider Information

NPI Number	:	1720813389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER C JEAN APRN

Provider Business Mailing Address
First Line	:	130 JOHN F KENNEDY DR STE 136
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6631
Country	:	US
Telephone Number	:	561-919-0090
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 JOHN F KENNEDY DR STE 136
Second Line	:
City	:	ATLANTIS
State	:	FL
Zip	:	33462-6631
Country	:	US
Telephone Number	:	561-919-0090
Fax Number	:

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

Provider Enumeration Date	:	09/04/2024
Last Update Date	:	09/16/2025

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