Provider Demographics
NPI:1255683124
Name:HART, JENNIFER L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:HART
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:GOLDRICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:202 N PARK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4148
Mailing Address - Country:US
Mailing Address - Phone:407-889-4711
Mailing Address - Fax:407-889-7742
Practice Address - Street 1:202 N PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4148
Practice Address - Country:US
Practice Address - Phone:407-889-4711
Practice Address - Fax:407-889-7742
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9250128363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9250128OtherADV NURSE PRACTITIONER