Provider Demographics
NPI:1629323407
Name:MAZORRA, JENNIFER J (NP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:MAZORRA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 29TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-8418
Mailing Address - Country:US
Mailing Address - Phone:239-821-4932
Mailing Address - Fax:
Practice Address - Street 1:625 9TH ST N
Practice Address - Street 2:SUITE 201
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-8143
Practice Address - Country:US
Practice Address - Phone:239-261-2000
Practice Address - Fax:239-261-2266
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9266223363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9266223OtherFLORIDA BOARD OF NURSING
FLRN9266223OtherFLORIDA BOARD OF NURSING