Provider Demographics
NPI:1427602820
Name:JENNINGS, INGA (APRN)
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8297 CHAMPIONS GATE BLVD # 463
Mailing Address - Street 2:
Mailing Address - City:CHAMPIONS GATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8387
Mailing Address - Country:US
Mailing Address - Phone:863-547-0788
Mailing Address - Fax:863-547-0789
Practice Address - Street 1:212 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-2801
Practice Address - Country:US
Practice Address - Phone:863-547-0788
Practice Address - Fax:863-547-0789
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003431163WP0000X, 2084N0400X, 208VP0014X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily