Provider Demographics
NPI:1790311215
Name:SEVILLA, JENNIFER LINDSEY (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LINDSEY
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LINDSEY
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1103 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-4108
Mailing Address - Country:US
Mailing Address - Phone:727-415-0872
Mailing Address - Fax:
Practice Address - Street 1:1831 N BELCHER RD STE F1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1453
Practice Address - Country:US
Practice Address - Phone:727-796-4544
Practice Address - Fax:727-726-4618
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily