Provider Demographics
NPI:1932616364
Name:IMPERATO, JENNIFER LORRAINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:IMPERATO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LORRAINE
Other - Last Name:TROFIBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-725-4505
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:7000 H C KELLEY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32831
Practice Address - Country:US
Practice Address - Phone:407-208-8307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-08
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3385012363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJJ977ZOtherMEDICARE
FLQG417OtherHF MA