Provider Demographics
NPI:1033454731
Name:SIEGEL, JENNIFER L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:445 S LAWRENCE BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-9222
Mailing Address - Country:US
Mailing Address - Phone:352-562-7927
Mailing Address - Fax:770-319-1019
Practice Address - Street 1:445 S LAWRENCE BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9222
Practice Address - Country:US
Practice Address - Phone:352-562-7927
Practice Address - Fax:770-319-1019
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9204294363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics