Provider Demographics
NPI:1902411986
Name:MINCEY, JENNIFER N
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:N
Last Name:MINCEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SW 8TH CT
Mailing Address - Street 2:
Mailing Address - City:FROSTPROOF
Mailing Address - State:FL
Mailing Address - Zip Code:33843-2458
Mailing Address - Country:US
Mailing Address - Phone:863-513-4103
Mailing Address - Fax:
Practice Address - Street 1:108 SW 8TH CT
Practice Address - Street 2:
Practice Address - City:FROSTPROOF
Practice Address - State:FL
Practice Address - Zip Code:33843-2458
Practice Address - Country:US
Practice Address - Phone:863-513-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care