Provider Demographics
NPI:1407168701
Name:PERKINS, JENNIFER D (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:PERKINS
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:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-3535
Mailing Address - Fax:239-343-4065
Practice Address - Street 1:42880 CRESCENT LOOP STE 110
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33982-5062
Practice Address - Country:US
Practice Address - Phone:239-343-3535
Practice Address - Fax:239-343-4065
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2523232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009794900Medicaid