Provider Demographics
NPI:1205215043
Name:PAUL, JENNIFER (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 S STATE ROAD 7 STE 370
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-7204
Mailing Address - Country:US
Mailing Address - Phone:754-204-2704
Mailing Address - Fax:
Practice Address - Street 1:6320 MIRAMAR PKWY STE H
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3999
Practice Address - Country:US
Practice Address - Phone:754-204-2704
Practice Address - Fax:754-701-7651
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9406460163W00000X
FL11012734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse