MEDICARE: JENNELYN IPO MONEDA 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	363LF0000X	Family Nurse Practitioner	ARNP9325543	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962984104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNELYN IPO MONEDA APRN

Provider Business Mailing Address
First Line	:	5400 PINEHURST DR
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34606-3833
Country	:	US
Telephone Number	:	352-277-5348
Fax Number	:	352-606-2857

Provider Business Practice Location Address
First Line	:	7615 JACQUE RD STE 102
Second Line	:
City	:	HUDSON
State	:	FL
Zip	:	34667-7132
Country	:	US
Telephone Number	:	727-255-0920
Fax Number	:	727-255-5560

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

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	03/31/2026

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