Provider Demographics
NPI:1508161498
Name:CANNESTRA, JENNIFER L (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:CANNESTRA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4495-304 ROOSEVELT BLVD. #296
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-5815
Mailing Address - Country:US
Mailing Address - Phone:904-868-4959
Mailing Address - Fax:
Practice Address - Street 1:4155 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-4425
Practice Address - Country:US
Practice Address - Phone:904-868-4959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2394171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist