Provider Demographics
NPI:1194187294
Name:MEYER, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3004 FOUNTAINHEAD CIR
Mailing Address - Street 2:APT# 116
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7328
Mailing Address - Country:US
Mailing Address - Phone:321-345-9022
Mailing Address - Fax:
Practice Address - Street 1:3004 FOUNTAINHEAD CIR
Practice Address - Street 2:APT# 116
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7328
Practice Address - Country:US
Practice Address - Phone:321-345-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-28
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5222398164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse