Provider Demographics
NPI:1659910545
Name:VIRGO, JENNIFER ANN MARIE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN MARIE
Last Name:VIRGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 NW 99TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5885
Mailing Address - Country:US
Mailing Address - Phone:954-297-8287
Mailing Address - Fax:
Practice Address - Street 1:12959 PALMS WEST DR STE 220
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4940
Practice Address - Country:US
Practice Address - Phone:954-274-3019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9199157163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty