Provider Demographics
NPI:1043590763
Name:BANNER, JENNIFER LEIGH (ARNP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LEIGH
Last Name:BANNER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:BANNER
Other - Last Name:CASSISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:103 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-3247
Mailing Address - Country:US
Mailing Address - Phone:352-577-5252
Mailing Address - Fax:888-522-4631
Practice Address - Street 1:103 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:FL
Practice Address - Zip Code:32693-3247
Practice Address - Country:US
Practice Address - Phone:352-577-5252
Practice Address - Fax:888-522-4631
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9183739363LF0000X
FLARNP9183739363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily