Provider Demographics
NPI:1033146964
Name:WERRELL, JENNIFER M (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:WERRELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3088 PALM TREE CT
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-5667
Mailing Address - Country:US
Mailing Address - Phone:215-370-9577
Mailing Address - Fax:
Practice Address - Street 1:8333 N. DAVIS HIGHWAY
Practice Address - Street 2:WEST FLORDIA MEDICAL CENTER CLINIC PA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514
Practice Address - Country:US
Practice Address - Phone:850-474-8220
Practice Address - Fax:850-969-2187
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001680152W00000X
FLOPC4401152W00000X
CAOPT13803TPL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700805744Medicare NSC
PA1759590Medicare ID - Type Unspecified
AR817ZMedicare PIN