WITT, JENNIFER RAE (CPNP)

Provider Demographics

• NPI: 1629190731
• Name: WITT, JENNIFER RAE (CPNP)
• Entity Type: Individual
• First Name: JENNIFER
• Middle Name: RAE
• Last Name: WITT
• Gender: F
• Credentials: CPNP
• Other - First Name: JENNIFER
• Other - Middle Name: RAE
• Other - Last Name: TIGNER
• Other - Last Name Type: Former Name
• Other - Credentials: CPNP
• Mailing Address - Street 1: 150 SW CHAMBER CT STE 101
• Mailing Address - City: PORT ST LUCIE
• Mailing Address - State: FL
• Mailing Address - Zip Code: 34986-3413
• Mailing Address - Country: US
• Practice Address - Street 1: 150 SW CHAMBER CT STE 101
• Practice Address - City: PORT ST LUCIE
• Practice Address - State: FL
• Practice Address - Zip Code: 34986-3413
• Practice Address - Country: US
• Practice Address - Phone: 772-301-0123
• Practice Address - Fax: 772-301-0124
• Is Sole Proprietor?: No
• Enumeration Date: 2007-04-06
• Last Update Date: 2023-11-07

Provider Licenses

State	License ID	Taxonomies
FL	APRN11008019	363LP0200X
NC	0050-1620	363LP0200X
NC	5001620	363L00000X
NC	203964	363LP0200X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	7005607	Medicaid
SC	NP3325	Medicaid
NC	1629190731	Medicaid
NC	AA9748H	Medicare PIN
NC	AA9748L	Medicare PIN
NC	AA9748M	Medicare PIN
NC	AA9748N	Medicare PIN
NC	AA9748G	Medicare PIN
NC	AA9748A	Medicare UPIN
NC	7005607	Medicaid
NC	AA9748O	Medicare PIN
NC	NC9097A	Medicare PIN
NC	AA9748I	Medicare PIN
NC	AA9748F	Medicare PIN
NC	AA9748D	Medicare PIN
NC	AA9748	Medicare UPIN
NC	1629190731	Medicaid
NC	AA9748K	Medicare PIN
NC	AA9748E	Medicare PIN
NC	AA9748B	Medicare PIN