Provider Demographics
NPI:1457625568
Name:MORTARA, JEANETTE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:MORTARA
Suffix:
Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 CLEAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32507-8126
Mailing Address - Country:US
Mailing Address - Phone:251-978-9780
Mailing Address - Fax:
Practice Address - Street 1:812 CREIGHTON RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-7028
Practice Address - Country:US
Practice Address - Phone:850-564-6644
Practice Address - Fax:866-740-0655
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 1952492363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health