Provider Demographics
NPI:1093256778
Name:LEVEROCK, JENNIFER JILL (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:JILL
Last Name:LEVEROCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NE 85TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3429
Mailing Address - Country:US
Mailing Address - Phone:786-301-0460
Mailing Address - Fax:
Practice Address - Street 1:1201 NE 85TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-3429
Practice Address - Country:US
Practice Address - Phone:786-301-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9327911163W00000X
FL514493367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse