Provider Demographics
NPI:1013481787
Name:EZIEFUOH, JENNIFER C (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:EZIEFUOH
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 1:8610 STATE ROAD 70 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-3785
Mailing Address - Country:US
Mailing Address - Phone:941-242-1929
Mailing Address - Fax:941-242-5116
Practice Address - Street 1:8610 STATE ROAD 70 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3785
Practice Address - Country:US
Practice Address - Phone:941-242-1929
Practice Address - Fax:941-242-5116
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner