Provider Demographics
NPI:1497987507
Name:FONSECA, JENNIFER DARLENE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DARLENE
Last Name:FONSECA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:DARLENE
Other - Last Name:FONSECA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1601 SW ARCHER RD
Mailing Address - Street 2:AMBULATORY CARE DEPARTMENT
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1135
Mailing Address - Country:US
Mailing Address - Phone:786-566-9988
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:AMBULATORY CARE DEPARTMENT
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:786-566-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9250016363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health