Provider Demographics
NPI:1184360331
Name:STILLWELL, JENNIFER LYN (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14708 CATLIN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7308
Mailing Address - Country:US
Mailing Address - Phone:443-365-1970
Mailing Address - Fax:
Practice Address - Street 1:2501 N ORANGE AVE STE 310
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4642
Practice Address - Country:US
Practice Address - Phone:407-303-2001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019549207RI0011X, 207Q00000X, 2080P0202X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology