Provider Demographics
NPI:1831643485
Name:CHILDERS, JENNIFER RUSS (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RUSS
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W MACCLENNY AVE
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2029
Mailing Address - Country:US
Mailing Address - Phone:904-259-6380
Mailing Address - Fax:
Practice Address - Street 1:121 W MACCLENNY AVE
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2029
Practice Address - Country:US
Practice Address - Phone:904-259-6380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3253932363LF0000X
FLARNP3253932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily