Provider Demographics
NPI:1720813389
Name:JEAN, JENNIFER C (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:JEAN
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 1:130 JOHN F KENNEDY DR STE 136
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-6631
Mailing Address - Country:US
Mailing Address - Phone:561-919-0090
Mailing Address - Fax:
Practice Address - Street 1:130 JOHN F KENNEDY DR STE 136
Practice Address - Street 2:
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-6631
Practice Address - Country:US
Practice Address - Phone:561-919-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9506400163W00000X
FL11042277363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse