Provider Demographics
NPI:1083854905
Name:JAMESON-LEE, NANETTE (APRN)
Entity Type:Individual
Prefix:
First Name:NANETTE
Middle Name:
Last Name:JAMESON-LEE
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 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7539
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6606 STADIUM DR STE A
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7510
Practice Address - Country:US
Practice Address - Phone:813-788-5575
Practice Address - Fax:813-355-5047
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN937432363LF0000X
FLARNP937432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002690100Medicaid
FLDR404ZMedicare PIN
FL$$$$$$$$$OtherTRICARE