Provider Demographics
NPI:1578994497
Name:WALKINSHAW, JENNIFER L (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WALKINSHAW
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13110 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7182
Mailing Address - Country:US
Mailing Address - Phone:813-349-7568
Mailing Address - Fax:813-349-7561
Practice Address - Street 1:508 N MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-3820
Practice Address - Country:US
Practice Address - Phone:813-349-7600
Practice Address - Fax:813-349-7661
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9237520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003123200Medicaid