Provider Demographics
NPI:1972013753
Name:JENNINGS, SHELLEY RENEE (RN,BSN)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:RENEE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 CHARLESTON CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-4412
Mailing Address - Country:US
Mailing Address - Phone:239-777-9329
Mailing Address - Fax:
Practice Address - Street 1:221 CHARLESTON CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-4412
Practice Address - Country:US
Practice Address - Phone:239-777-9329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3074462163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse