Provider Demographics
NPI:1174864482
Name:VON STROH, JENNIFER LEE (BSHS, MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEE
Last Name:VON STROH
Suffix:
Gender:F
Credentials:BSHS, MSN, FNP-BC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSHS, MSN, FNP-BC
Mailing Address - Street 1:800 WILDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4870
Mailing Address - Country:US
Mailing Address - Phone:386-848-8620
Mailing Address - Fax:
Practice Address - Street 1:1630 MASON AVE STE C
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-238-9064
Practice Address - Fax:386-238-9063
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265808363LF0000X
NMCNP02201207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily