Provider Demographics
NPI:1093229577
Name:PETERSON, JENNIFER CATHERINE (DNP, ARNP, FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:DNP, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5561 NW 49TH WAY
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3725
Mailing Address - Country:US
Mailing Address - Phone:954-234-1237
Mailing Address - Fax:
Practice Address - Street 1:5561 NW 49TH WAY
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-3725
Practice Address - Country:US
Practice Address - Phone:954-234-1237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9385244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily