Provider Demographics
NPI:1235877606
Name:EZAVIN, JENNIFER (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EZAVIN
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 1:1421 E OAKLAND PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4434
Mailing Address - Country:US
Mailing Address - Phone:954-565-0875
Mailing Address - Fax:954-565-0876
Practice Address - Street 1:1421 E OAKLAND PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4434
Practice Address - Country:US
Practice Address - Phone:954-565-0875
Practice Address - Fax:954-565-0876
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLAPRN11024153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program