Provider Demographics
NPI:1881980043
Name:GREENFIELD, JENNIFER MARGO (ARNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARGO
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:SCHNEIDER
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP-BC
Mailing Address - Street 1:2682 ADDISON DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7818
Mailing Address - Country:US
Mailing Address - Phone:321-960-4186
Mailing Address - Fax:
Practice Address - Street 1:6013 FARCENDA PL STE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7331
Practice Address - Country:US
Practice Address - Phone:321-655-5515
Practice Address - Fax:321-241-4312
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9269354363LP0808X
FLARNP 9269354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOP783OtherFL HF MEDICARE