Provider Demographics
NPI:1881233526
Name:GREENIDGE, JANADRA DEAN (APRN)
Entity type:Individual
Prefix:MISS
First Name:JANADRA
Middle Name:DEAN
Last Name:GREENIDGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:JANADRA
Other - Middle Name:DEAN
Other - Last Name:GREENIDGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:5979 VINELAND RD STE 207
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7855
Mailing Address - Country:US
Mailing Address - Phone:407-893-1181
Mailing Address - Fax:407-440-8269
Practice Address - Street 1:5979 VINELAND RD STE 207
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7855
Practice Address - Country:US
Practice Address - Phone:407-893-1181
Practice Address - Fax:407-440-8269
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-28
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005463363LF0000X
FLAPRN11005463363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily