Provider Demographics
NPI:1013563337
Name:DRINKARD, JERRY DWAIN II (FNP)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:DWAIN
Last Name:DRINKARD
Suffix:II
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HIGHWAY 196
Mailing Address - Street 2:
Mailing Address - City:MOLINO
Mailing Address - State:FL
Mailing Address - Zip Code:32577-5258
Mailing Address - Country:US
Mailing Address - Phone:251-295-3777
Mailing Address - Fax:
Practice Address - Street 1:1101 HIGHWAY 196
Practice Address - Street 2:
Practice Address - City:MOLINO
Practice Address - State:FL
Practice Address - Zip Code:32577-5258
Practice Address - Country:US
Practice Address - Phone:251-295-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002810363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily