Provider Demographics
NPI:1881107019
Name:WEINBERG, JEREMY SCOTT (APRN)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:SCOTT
Last Name:WEINBERG
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 NE 20TH ST APT 716
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-2159
Mailing Address - Country:US
Mailing Address - Phone:504-533-4895
Mailing Address - Fax:408-531-6795
Practice Address - Street 1:6521 N ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2131
Practice Address - Country:US
Practice Address - Phone:954-941-6301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016417363LF0000X
LAAP09640363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily