Provider Demographics
NPI:1104970409
Name:PAUL, JENNIFER J (RN CNOR CRNFA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:J
Last Name:PAUL
Suffix:
Gender:F
Credentials:RN CNOR CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16295 S. TAMIAMI TRAIL #183
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5326
Mailing Address - Country:US
Mailing Address - Phone:239-433-0035
Mailing Address - Fax:239-433-0035
Practice Address - Street 1:16295 S. TAMIAMI TRAIL #183
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5326
Practice Address - Country:US
Practice Address - Phone:239-433-0035
Practice Address - Fax:239-267-5661
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1748502163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL310013800Medicaid
FLY6478OtherBCBS PROVIDER NUMBER