Provider Demographics
NPI:1770092215
Name:ZELJKOVIC, JENNIFER LAUREN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:ZELJKOVIC
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LAUREN
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1703 W. THONOTOSASSA RD A
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563
Mailing Address - Country:US
Mailing Address - Phone:813-567-5679
Mailing Address - Fax:
Practice Address - Street 1:1703 W. THONOTOSASSA RD. A
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563
Practice Address - Country:US
Practice Address - Phone:813-567-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9342463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily