Provider Demographics
NPI:1780021154
Name:EMANUEL, JENNIFER M (RN, APRN-CNM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:EMANUEL
Suffix:
Gender:F
Credentials:RN, APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 OUTREACH WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-3405
Mailing Address - Country:US
Mailing Address - Phone:941-529-0200
Mailing Address - Fax:
Practice Address - Street 1:6950 OUTREACH WAY
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-3405
Practice Address - Country:US
Practice Address - Phone:941-529-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-25
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN532955163WX0003X
PAMW010311367A00000X
FLAPRN11011847367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient