Provider Demographics
NPI:1629629860
Name:REVELL, JENIFFER (DOULA)
Entity Type:Individual
Prefix:MRS
First Name:JENIFFER
Middle Name:
Last Name:REVELL
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 NW 39TH AVE STE 1303289
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7331
Mailing Address - Country:US
Mailing Address - Phone:352-559-5062
Mailing Address - Fax:
Practice Address - Street 1:9200 NW 39TH AVE
Practice Address - Street 2:STE 130 - 3289
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-3210
Practice Address - Country:US
Practice Address - Phone:352-559-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174N00000XOther Service ProvidersLactation Consultant, Non-RN