Provider Demographics
NPI:1114007630
Name:RAFUS, JENNIFER MILLER (MS, FNP, LIC AC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MILLER
Last Name:RAFUS
Suffix:
Gender:F
Credentials:MS, FNP, LIC AC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MILLER
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSFNP
Mailing Address - Street 1:615A PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4724
Mailing Address - Country:US
Mailing Address - Phone:912-548-0710
Mailing Address - Fax:912-548-0071
Practice Address - Street 1:615A PENDLETON ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4724
Practice Address - Country:US
Practice Address - Phone:912-548-0710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235259363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health