Provider Demographics
NPI:1609861467
Name:WINFIELD, JEAN P (APN)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:P
Last Name:WINFIELD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5804 INDIAN PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34951-2302
Mailing Address - Country:US
Mailing Address - Phone:772-828-3752
Mailing Address - Fax:
Practice Address - Street 1:5804 INDIAN PINES BLVD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34951-2302
Practice Address - Country:US
Practice Address - Phone:772-828-3752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9494502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428769608Medicaid
KS100459080AMedicaid
KS100459080AMedicaid
MOP96483Medicare UPIN