Provider Demographics
NPI:1356548770
Name:MONTRESSOR, JENNIFER VICTORIA (RNFA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VICTORIA
Last Name:MONTRESSOR
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 EISENHOWER BLVD
Mailing Address - Street 2:#300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-6310
Mailing Address - Country:US
Mailing Address - Phone:810-220-5296
Mailing Address - Fax:
Practice Address - Street 1:4301 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6546
Practice Address - Country:US
Practice Address - Phone:810-220-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220536163WR0006X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant