Provider Demographics
NPI:1356863732
Name:EBERHARD, JENNIFER (DNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:EBERHARD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:335 OXFORD ESTATES WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-6622
Mailing Address - Country:US
Mailing Address - Phone:321-544-4535
Mailing Address - Fax:
Practice Address - Street 1:335 OXFORD ESTATES WAY
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259
Practice Address - Country:US
Practice Address - Phone:321-544-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9333112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily