Provider Demographics
NPI:1710974175
Name:MACDONALD, JENNIFER C (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:C
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 WELLNESS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8396
Mailing Address - Country:US
Mailing Address - Phone:386-668-4650
Mailing Address - Fax:386-668-4649
Practice Address - Street 1:2877 WELLNESS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8396
Practice Address - Country:US
Practice Address - Phone:386-668-4650
Practice Address - Fax:386-668-4649
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2615892363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303851700Medicaid
FLE5076WMedicare PIN
FL303851700Medicaid