Provider Demographics
NPI:1932886298
Name:HALL, JENNIFER SUE (APRN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SUE
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 HARVARDSTON LOOP
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-1028
Mailing Address - Country:US
Mailing Address - Phone:727-967-3680
Mailing Address - Fax:
Practice Address - Street 1:3180 HARVARDSTON LOOP
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-1028
Practice Address - Country:US
Practice Address - Phone:727-967-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily