Provider Demographics
NPI:1457513400
Name:GJERTSEN, JENNIFER LEE (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:GJERTSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 N MCMULLEN BOOTH RD
Mailing Address - Street 2:SUITE 510 #163
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-4173
Mailing Address - Country:US
Mailing Address - Phone:727-415-8899
Mailing Address - Fax:
Practice Address - Street 1:2519 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE 510 #163
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-4173
Practice Address - Country:US
Practice Address - Phone:727-415-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9181873367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered