Provider Demographics
NPI:1013905397
Name:BHATIA, JENNIFER TONEY (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TONEY
Last Name:BHATIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:TONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:6420 W NEWBERRY RD
Practice Address - Street 2:EAST WING, SUITE 100
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4308
Practice Address - Country:US
Practice Address - Phone:352-332-3900
Practice Address - Fax:352-332-5009
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2635142363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHS919ZMedicare PIN
FLARNP 2635142OtherSTATE LICENSE NUMBER
FL5574630001Medicare NSC