Provider Demographics
NPI:1619675311
Name:JEUDI, JENNY C (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JENNY
Middle Name:C
Last Name:JEUDI
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5416 SANDBIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7201
Mailing Address - Country:US
Mailing Address - Phone:516-495-0552
Mailing Address - Fax:
Practice Address - Street 1:3450 LANTANA RD STE 100
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33462-1304
Practice Address - Country:US
Practice Address - Phone:561-965-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2022001273363LF0000X
FL11024928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily