Provider Demographics
NPI:1477946903
Name:HUCK, JENNIFER (DNP FNP-BC AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HUCK
Suffix:
Gender:F
Credentials:DNP FNP-BC AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5185 N HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:PALM SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7210
Mailing Address - Country:US
Mailing Address - Phone:619-339-6506
Mailing Address - Fax:
Practice Address - Street 1:5185 N HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:PALM SHORES
Practice Address - State:FL
Practice Address - Zip Code:32940-7210
Practice Address - Country:US
Practice Address - Phone:619-339-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760200363LA2200X, 363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology