Provider Demographics
NPI:1639996663
Name:JABRUKLLC
Entity type:Organization
Organization Name:JABRUKLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:561-768-4880
Mailing Address - Street 1:173 VIA ROSINA
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6934
Mailing Address - Country:US
Mailing Address - Phone:562-768-4880
Mailing Address - Fax:561-768-4890
Practice Address - Street 1:173 VIA ROSINA
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6934
Practice Address - Country:US
Practice Address - Phone:562-768-4880
Practice Address - Fax:561-768-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty