Provider Demographics
NPI:1568010197
Name:MCCONNELL, JENNIFER M (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 NW 57TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-6437
Mailing Address - Country:US
Mailing Address - Phone:352-474-8686
Mailing Address - Fax:352-364-4163
Practice Address - Street 1:919 NW 57TH ST STE 10
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6437
Practice Address - Country:US
Practice Address - Phone:352-474-8686
Practice Address - Fax:352-364-4163
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9218640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine