Provider Demographics
NPI:1780171157
Name:BOTKINS, JENNIFER DAWN (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:BOTKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:SPOOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2590 HEALING WAY STE 210
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5497
Practice Address - Country:US
Practice Address - Phone:813-782-5801
Practice Address - Fax:813-782-5732
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9280354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100133000Medicaid
FLJNUFROtherBLUE CROSS BLUE SHIELD