Provider Demographics
NPI:1245638014
Name:FLORENTINO, JENNIFER P (FPA NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:FLORENTINO
Suffix:
Gender:F
Credentials:FPA NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SOLARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1039
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:5500 COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:HANOVER PARK
Practice Address - State:IL
Practice Address - Zip Code:60133-5104
Practice Address - Country:US
Practice Address - Phone:800-323-8622
Practice Address - Fax:224-225-0370
Is Sole Proprietor?:No
Enumeration Date:2014-12-10
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012044363LF0000X
IL277-001401363LF0000X
WI23137363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner