Provider Demographics
NPI:1912480245
Name:JEFFERSON, TINESHA PRINTELLA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TINESHA
Middle Name:PRINTELLA
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:TINESHA
Other - Middle Name:PRINTELLA
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:7200 NORMANDY BLVD STE 20
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-6271
Practice Address - Country:US
Practice Address - Phone:904-378-8520
Practice Address - Fax:904-378-8570
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN816542363L00000X
FLAPRN9293754363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care