Jack, Jennifer R

Jack, Jennifer R is an individual health care provider with primary practice located at 15901 Bass Rd Ste 102 , Fort Myers FL 33908-3838. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Jack, Jennifer R can be contacted via phone (239) 343-9890.

Contact Information

Primary practice address
15901 Bass Rd Ste 102 Fort Myers FL 33908-3838
Phone: (239) 343-9890
Fax: (239) 343-9898
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 28148319A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 71004791A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X APRN11019090 Florida

Profile Details

NPI number 1184045148
LBN Legal business name Jack, Jennifer R
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 18th, 2013
Last updated May 3rd, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184045148 NPPES
Florida MEDICAID 113907600

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