Provider Demographics
NPI:1003483637
Name:REESE, JENNIFER RENA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RENA
Last Name:REESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15207 LITTLE FILLY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32234-2340
Mailing Address - Country:US
Mailing Address - Phone:904-844-1086
Mailing Address - Fax:
Practice Address - Street 1:15207 LITTLE FILLY CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32234-2340
Practice Address - Country:US
Practice Address - Phone:904-844-1086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347C00000XTransportation ServicesPrivate VehicleGroup - Single Specialty
No332U00000XSuppliersHome Delivered Meals
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No174200000XOther Service ProvidersMeals