Provider Demographics
NPI:1720463771
Name:BATES, JENNIFFER MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFFER
Middle Name:MARIE
Last Name:BATES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:587 FIRST CAPE CORAL DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5925
Mailing Address - Country:US
Mailing Address - Phone:321-402-4623
Mailing Address - Fax:
Practice Address - Street 1:3480 POLYNESIAN ISLE BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746
Practice Address - Country:US
Practice Address - Phone:407-507-2615
Practice Address - Fax:407-506-2616
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9257972363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health