Provider Demographics
NPI:1346671468
Name:TERRY, JENNIFER ELLEN (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:TERRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12124 PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-3532
Mailing Address - Country:US
Mailing Address - Phone:352-442-5325
Mailing Address - Fax:
Practice Address - Street 1:12124 PIONEER AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-3532
Practice Address - Country:US
Practice Address - Phone:352-442-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-30
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2731942363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHR996UMedicare PIN
FLHR996SMedicare PIN
FLHR996TMedicare PIN