Provider Demographics
NPI:1083614952
Name:EVERETT, JEANNINE LOUISE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JEANNINE
Middle Name:LOUISE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JEANNINE
Other - Middle Name:LOUISE
Other - Last Name:EVERETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:6 PERROTTI PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-7452
Mailing Address - Country:US
Mailing Address - Phone:239-936-5250
Mailing Address - Fax:239-936-9970
Practice Address - Street 1:43 BARKLEY CIR
Practice Address - Street 2:STE. 201
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4510
Practice Address - Country:US
Practice Address - Phone:239-936-5250
Practice Address - Fax:239-936-9970
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28140609A101Y00000X
IN70000188A364S00000X
FLARNP9428067363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017341900Medicaid
FL017341900Medicaid
Q22945Medicare UPIN
141570IMedicare ID - Type Unspecified