Provider Demographics
NPI:1336173962
Name:GEARY, JEAN ALICE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ALICE
Last Name:GEARY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:ALICE
Other - Last Name:BRADEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:4740 STAFFORD CT
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-2565
Mailing Address - Country:US
Mailing Address - Phone:941-932-1429
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:941-348-7421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9180123363LF0000X
TX835568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306252000Medicaid