Provider Demographics
NPI:1609384981
Name:VEGA, JENNIFER SIAPNO (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SIAPNO
Last Name:VEGA
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 1:12118 SW 137TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6046
Mailing Address - Country:US
Mailing Address - Phone:786-210-8508
Mailing Address - Fax:
Practice Address - Street 1:6280 SUNSET DR STE 501
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4870
Practice Address - Country:US
Practice Address - Phone:305-671-3447
Practice Address - Fax:305-671-3739
Is Sole Proprietor?:No
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9326053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily