Provider Demographics
NPI:1467038240
Name:ERVIN, JENNIFER RICKS (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RICKS
Last Name:ERVIN
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 1:4480 PHILODENDRON CT
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8612
Mailing Address - Country:US
Mailing Address - Phone:904-813-9485
Mailing Address - Fax:
Practice Address - Street 1:2060 HIGHWAY A1A STE 304
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3596
Practice Address - Country:US
Practice Address - Phone:904-813-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11011762363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health