Provider Demographics
NPI:1083245906
Name:JENNINGS, SHELLEY (APRN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1178 VILLAGE FOREST PL
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8108
Mailing Address - Country:US
Mailing Address - Phone:407-760-7510
Mailing Address - Fax:
Practice Address - Street 1:1178 VILLAGE FOREST PL
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-8108
Practice Address - Country:US
Practice Address - Phone:407-760-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005363363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily