Provider Demographics
NPI:1538309166
Name:WINSTON, JENNIFER ADAMS (DPT)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ADAMS
Last Name:WINSTON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E RED HOUSE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-6502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1835 EASTWEST PKWY
Practice Address - Street 2:SUITE #16
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-6336
Practice Address - Country:US
Practice Address - Phone:904-215-3958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-22
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24567225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist