Provider Demographics
NPI:1831423797
Name:JENNINGS, DEBORAH O (FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:O
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 PAYNE STEWART DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-9208
Mailing Address - Country:US
Mailing Address - Phone:904-360-8200
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:4811 PAYNE STEWART DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-9208
Practice Address - Country:US
Practice Address - Phone:904-360-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9466101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily