Provider Demographics
NPI:1104178896
Name:GROOMS, JENIFER (CRNP, APRN)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:GROOMS
Suffix:
Gender:F
Credentials:CRNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7631 CITRUS BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7471
Mailing Address - Country:US
Mailing Address - Phone:724-541-0222
Mailing Address - Fax:
Practice Address - Street 1:17929 HUNTING BOW CIR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5378
Practice Address - Country:US
Practice Address - Phone:813-792-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012418363L00000X
FL11005606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner