Provider Demographics
NPI:1174922769
Name:KUNDRAT, JENNIFER (CRNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KUNDRAT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5590
Mailing Address - Country:US
Mailing Address - Phone:386-274-2977
Mailing Address - Fax:386-274-2997
Practice Address - Street 1:1671 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5590
Practice Address - Country:US
Practice Address - Phone:386-274-2977
Practice Address - Fax:386-274-2997
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9438010363L00000X
PASP014119363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health