Provider Demographics
NPI:1821521261
Name:AYREY, JENNIFER LYN (APRN-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:AYREY
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-C
Mailing Address - Street 1:1347 GEM CIR
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6420
Mailing Address - Country:US
Mailing Address - Phone:321-917-6788
Mailing Address - Fax:321-284-8620
Practice Address - Street 1:1347 GEM CIR
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6420
Practice Address - Country:US
Practice Address - Phone:321-917-6788
Practice Address - Fax:321-284-8620
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9238948363L00000X
FLARNP9238948363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021228600Medicaid