Provider Demographics
NPI:1275522617
Name:SIDDONS, JENNIFER ANDERSON (ARNP MSN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANDERSON
Last Name:SIDDONS
Suffix:
Gender:F
Credentials:ARNP MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2179 S TAMIAMI TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-9608
Mailing Address - Country:US
Mailing Address - Phone:941-966-0222
Mailing Address - Fax:941-966-0222
Practice Address - Street 1:2179 S TAMIAMI TRL STE 101
Practice Address - Street 2:
Practice Address - City:OSPREY
Practice Address - State:FL
Practice Address - Zip Code:34229-9608
Practice Address - Country:US
Practice Address - Phone:941-966-0222
Practice Address - Fax:941-966-0222
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3390012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304353300Medicaid
FL304353300Medicaid
FLE6882YMedicare PIN